Provider Demographics
NPI:1710984794
Name:GOODMAN, IRA J (MD)
Entity Type:Individual
Prefix:DR
First Name:IRA
Middle Name:J
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7055 HIGH GROVE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7593
Mailing Address - Country:US
Mailing Address - Phone:630-371-9980
Mailing Address - Fax:630-371-9983
Practice Address - Street 1:7055 HIGH GROVE BLVD
Practice Address - Street 2:SUITE 10
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7593
Practice Address - Country:US
Practice Address - Phone:630-371-9980
Practice Address - Fax:630-371-9983
Is Sole Proprietor?:No
Enumeration Date:2005-07-05
Last Update Date:2014-10-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036082680174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist