Individual
RICHARD J GOLDBERG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 E WISCONSIN AVE, MILWAUKEE, WI 53202-4815
(414) 290-6720
(414) 290-6755
Mailing address
111 E WISCONSIN AVE, MILWAUKEE, WI 53202-4815
(414) 290-6720
(414) 290-6755
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
036073524
IL
207P00000X
Emergency Medicine Physician
Primary
39505-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036073524
—
IL
05
—
34267900
—
WI
01
—
930062819
TRICARE NORTH REGION
IL
01
—
930122225
MEDICARE RAILROAD
WI
01
—
930122226
MEDICARE RAILROAD
WI
05
—
99419601
—
AZ
01
—
P00076349
MEDICARE RAILROAD
IL
Enumeration date
05/30/2006
Last updated
01/29/2009
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