Provider Demographics
NPI:1255347811
Name:GOOMAR, PRITH M (MD)
Entity type:Individual
Prefix:DR
First Name:PRITH
Middle Name:M
Last Name:GOOMAR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4711 GOLF RD STE 806
Mailing Address - Street 2:
Mailing Address - City:SKOKIE
Mailing Address - State:IL
Mailing Address - Zip Code:60076-1246
Mailing Address - Country:US
Mailing Address - Phone:847-763-1334
Mailing Address - Fax:847-763-1737
Practice Address - Street 1:4711 GOLF RD STE 806
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60076-1246
Practice Address - Country:US
Practice Address - Phone:847-763-1334
Practice Address - Fax:847-763-1737
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG42357Medicare UPIN
IL215070Medicare ID - Type Unspecified