Organization
ADDICTION WELLNESS SERVICES INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GAGANDEEP GOYAL MD (PRESIDENT)
(267) 226-4760
Entity
Organization
Contact information
Practice address
5504 N 2ND ST, LOVES PARK, IL 61111-5013
(815) 997-4516
Mailing address
3824 NORTHERN PIKE STE 600, MONROEVILLE, PA 15146-2156
(412) 457-0175
(412) 457-0179
Taxonomy
Speciality
Code
Description
License number
State
207LP3000X
Pediatric Anesthesiology Physician
Primary
MD438154
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
036144684
IL LICENSE
IL
01
—
MD438154
PA LICENSE
PA
Enumeration date
11/22/2017
Last updated
01/29/2019
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