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Individual

GREGORY T GOLDSTEIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
1638 W SURF ST, CHICAGO, IL 60657-3599
(312) 890-3999
(847) 919-3849
Mailing address
1638 W SURF ST, CHICAGO, IL 60657-3599
(312) 890-3999
(847) 919-3849

Taxonomy

Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
036104855
IL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036104855
IL
01
1615479
BCBS
IL
01
3001384006
RR MC
01
CN0576
GROUP #
01
PTAN IL 1739
MRI OF CHICAGO, LLC
IL
Enumeration date
02/17/2006
Last updated
07/07/2009
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