# J I GOLDMAN MD PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1144340308
- **Authorized official:** JAROSLAV GOLDMAN M,D, (PRESIDENT)
- **Authorized official phone:** (312) 787-4916

## Contact information

- **Practice address:** 4646 N MARINE DR, B 125, CHICAGO, IL 60640-5759
- **Practice address phone:** (773) 572-0032
- **Practice address fax:** (773) 572-0029
- **Mailing address:** 33 W ONTARIO ST APT 36B, CHICAGO, IL 60654-7771
- **Mailing address phone:** (312) 787-4916

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207R00000X | Internal Medicine Physician | 036100764 | IL | Yes |

## Other

- **Enumeration date:** 03/30/2007
- **Last updated:** 12/16/2009