Provider Demographics
NPI:1548574296
Name:ASGEDOM, GOITOM ANDOM (MD)
Entity Type:Individual
Prefix:DR
First Name:GOITOM
Middle Name:ANDOM
Last Name:ASGEDOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 QUADRANGLE DR
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-3412
Mailing Address - Country:US
Mailing Address - Phone:866-727-4612
Mailing Address - Fax:630-914-7048
Practice Address - Street 1:1000 MCKINLEY PARK DR
Practice Address - Street 2:
Practice Address - City:MARION
Practice Address - State:OH
Practice Address - Zip Code:43302-6399
Practice Address - Country:US
Practice Address - Phone:866-727-4612
Practice Address - Fax:630-914-7048
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.122607207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine