Provider Demographics
NPI:1184619785
Name:GOLDIN, HARRY M (MD)
Entity type:Individual
Prefix:DR
First Name:HARRY
Middle Name:M
Last Name:GOLDIN
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 1:4709 GOLF RD
Mailing Address - Street 2:1000
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1231
Mailing Address - Country:US
Mailing Address - Phone:847-677-2080
Mailing Address - Fax:847-677-2098
Practice Address - Street 1:4709 GOLF RD
Practice Address - Street 2:1000
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1231
Practice Address - Country:US
Practice Address - Phone:847-677-2080
Practice Address - Fax:847-677-2098
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL336027611174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL776101Medicare ID - Type UnspecifiedMEDICARE NUMBER