Provider Demographics
NPI:1568578607
Name:GOYAL, NINA A (MD)
Entity Type:Individual
Prefix:
First Name:NINA
Middle Name:A
Last Name:GOYAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:1725 W HARRISON ST
Mailing Address - Street 2:918
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3841
Mailing Address - Country:US
Mailing Address - Phone:312-942-2734
Mailing Address - Fax:312-942-2156
Practice Address - Street 1:1725 W HARRISON ST
Practice Address - Street 2:918
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3841
Practice Address - Country:US
Practice Address - Phone:312-942-2734
Practice Address - Fax:312-942-2156
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-115900207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036115900Medicaid
ILK44311Medicare PIN