Provider Demographics
NPI:1649606898
Name:GOLDBERG, ALAN HERBERT (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:HERBERT
Last Name:GOLDBERG
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 1:1800 N. PROSPECT AVE.
Mailing Address - Street 2:APT. 11C
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-3069
Mailing Address - Country:US
Mailing Address - Phone:414-964-2120
Mailing Address - Fax:
Practice Address - Street 1:1800 N PROSPECT AVE
Practice Address - Street 2:APT. 11C
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-3070
Practice Address - Country:US
Practice Address - Phone:414-964-2120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI24162207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI24162OtherMEDICAL LICENCE NUMBER
WI24162OtherMEDICAL LICENCE NUMBER