Individual
DR. STEPHEN GOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 NE GLEN OAK AVE, PEORIA, IL 61637-3522
(309) 655-2000
Mailing address
111 OAKWOOD RD, EAST PEORIA, IL 61611-1853
(309) 740-4272
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036-149255
IL
2085R0202X
Diagnostic Radiology Physician
61631
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1285999334
—
WI
Enumeration date
07/05/2012
Last updated
10/23/2023
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