Individual
DR. MATTHEW BRENT GOREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
TWO PRUDENTIAL PLAZA, SUITE 3175, CHICAGO, IL 60601-6719
(312) 332-2262
(312) 819-1316
Mailing address
TWO PRUDENTIAL PLAZA, SUITE 3175, CHICAGO, IL 60601-6719
(312) 332-2262
(312) 819-1316
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0001604949
BLUE SHIELD PROVIDER NO
IL
Enumeration date
11/16/2006
Last updated
07/08/2007
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