Provider Demographics
NPI:1720364953
Name:GOSS, NOAH RYAN (PA-C)
Entity Type:Individual
Prefix:MR
First Name:NOAH
Middle Name:RYAN
Last Name:GOSS
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:3023 N CLARK ST
Mailing Address - Street 2:200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60657-5200
Mailing Address - Country:US
Mailing Address - Phone:312-623-2625
Mailing Address - Fax:773-327-6622
Practice Address - Street 1:2551 N CLARK ST
Practice Address - Street 2:203
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60614-1798
Practice Address - Country:US
Practice Address - Phone:312-623-2625
Practice Address - Fax:773-327-6622
Is Sole Proprietor?:No
Enumeration Date:2011-11-02
Last Update Date:2014-06-26
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Provider Licenses
StateLicense IDTaxonomies
IL085004218363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant