Provider Demographics
NPI:1770564122
Name:FINEGOLD, RICHARD D (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:D
Last Name:FINEGOLD
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 1:172 SCHILLER
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2885
Mailing Address - Country:US
Mailing Address - Phone:331-221-9000
Mailing Address - Fax:331-221-3904
Practice Address - Street 1:172 SCHILLER
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2885
Practice Address - Country:US
Practice Address - Phone:331-221-9001
Practice Address - Fax:331-221-3904
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2015-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036072555207R00000X, 207RB0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RB0002XAllopathic & Osteopathic PhysiciansInternal MedicineObesity Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILDG5947OtherRAILROAD MEDICARE GROUP
IL110246884OtherRAILROAD MEDICAE INDIVID
ILDG5947OtherRAILROAD MEDICARE GROUP
IL110246884OtherRAILROAD MEDICAE INDIVID
208455Medicare ID - Type UnspecifiedGROUP