Provider Demographics
NPI:1619962941
Name:GOLDFAIN, VALERIE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:MARIE
Last Name:GOLDFAIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 N WALL ST
Mailing Address - Street 2:STE P410
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3483
Mailing Address - Country:US
Mailing Address - Phone:815-932-7474
Mailing Address - Fax:815-937-8206
Practice Address - Street 1:375 N WALL ST
Practice Address - Street 2:STE P410
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3483
Practice Address - Country:US
Practice Address - Phone:815-932-7474
Practice Address - Fax:815-937-8206
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036097311207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036097311Medicaid
G03848Medicare UPIN
IL036097311Medicaid