Individual
DR. DAVID A GOODMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
390 E CONGRESS PKWY, UNIT M, CRYSTAL LAKE, IL 60014-6202
(815) 455-0858
Mailing address
390 E CONGRESS PKWY, UNIT M, CRYSTAL LAKE, IL 60014-6202
(815) 455-0858
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036073838 1
—
IL
Enumeration date
01/03/2007
Last updated
07/08/2007
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