Provider Demographics
NPI:1811138076
Name:GEORGE W. GOODLOW, MD, PEDIATRICS, LLC
Entity type:Organization
Organization Name:GEORGE W. GOODLOW, MD, PEDIATRICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:W
Authorized Official - Last Name:GOODLOW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-797-0587
Mailing Address - Street 1:3295 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-1565
Mailing Address - Country:US
Mailing Address - Phone:847-797-0587
Mailing Address - Fax:847-797-1020
Practice Address - Street 1:3295 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE 106-107
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-1565
Practice Address - Country:US
Practice Address - Phone:847-797-0587
Practice Address - Fax:847-797-1020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-050051208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty