Provider Demographics
NPI:1700138146
Name:GOLDENBERG, HARRIS S (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRIS
Middle Name:S
Last Name:GOLDENBERG
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 1:2617 GREENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-7622
Mailing Address - Country:US
Mailing Address - Phone:847-530-2226
Mailing Address - Fax:
Practice Address - Street 1:2617 GREENWOOD RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-7622
Practice Address - Country:US
Practice Address - Phone:847-530-2226
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-09
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036043474208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
BG9698486OtherDEA