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Individual

DR. EDWARD J. GOLDBERG

Active
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Individual

DR. EDWARD J. GOLDBERG

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Taxonomy

Speciality
Code
Description
License number
State
207XS0117X
Orthopaedic Surgery of the Spine Physician
Primary
036070258
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036070258 3
IL
01
1633878
BCBS GROUP ID#
IL
01
207067
MEDICARE PTAN LOCALITY 16
IL
01
207073
MEDICARE PTAN LOCALITY 15
IL
01
4122886
AETNA ID#
IL
01
DA4902
RR MEDICARE PTAN#
IL
01
P00150808
RR MEDICARE ID#
IL
Enumeration date
01/11/2006
Last updated
09/18/2018
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