Provider Demographics
NPI:1912401308
Name:GOODMAN, EMILY ANN (MD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ANN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:180 HARVESTER DR. STE 110
Mailing Address - Street 2:
Mailing Address - City:BURR RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60527-6686
Mailing Address - Country:US
Mailing Address - Phone:773-702-1150
Mailing Address - Fax:
Practice Address - Street 1:5841 S. MARYLAND AVE. M/C 6040
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-2401
Practice Address - Country:US
Practice Address - Phone:773-702-1860
Practice Address - Fax:773-926-0732
Is Sole Proprietor?:No
Enumeration Date:2018-03-20
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036.165209208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery