Provider Demographics
NPI:1508998683
Name:GOLDMAN, STEVEN J (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:J
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:624 HUBER LN
Mailing Address - Street 2:
Mailing Address - City:GLENVIEW
Mailing Address - State:IL
Mailing Address - Zip Code:60025-4064
Mailing Address - Country:US
Mailing Address - Phone:847-724-9300
Mailing Address - Fax:888-998-9338
Practice Address - Street 1:624 HUBER LN
Practice Address - Street 2:
Practice Address - City:GLENVIEW
Practice Address - State:IL
Practice Address - Zip Code:60025-4064
Practice Address - Country:US
Practice Address - Phone:847-724-9300
Practice Address - Fax:888-998-9338
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-12
Last Update Date:2014-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-080960261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty