Provider Demographics
NPI:1669466801
Name:GOSWAMI, UMESH P (MD)
Entity Type:Individual
Prefix:DR
First Name:UMESH
Middle Name:P
Last Name:GOSWAMI
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 1:599 PEARSON DR
Mailing Address - Street 2:
Mailing Address - City:GENOA
Mailing Address - State:IL
Mailing Address - Zip Code:60135-1355
Mailing Address - Country:US
Mailing Address - Phone:815-784-6437
Mailing Address - Fax:815-784-3933
Practice Address - Street 1:599 PEARSON DR
Practice Address - Street 2:
Practice Address - City:GENOA
Practice Address - State:IL
Practice Address - Zip Code:60135-1355
Practice Address - Country:US
Practice Address - Phone:815-784-6437
Practice Address - Fax:815-784-3933
Is Sole Proprietor?:No
Enumeration Date:2005-09-02
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036058246208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036058246Medicaid
IL036058246Medicaid
ILC44300Medicare UPIN