Edward NMN Goldsborough IV, IDC

Primary specialty

Independent Duty CorpsmanTaxonomy code 1710I1002X

Practice address

3001 A 6TH St
Great Lakes, IL 60088

Phone

(847) 688-4560

NPI assigned

Jul 24, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1185235200000",
    "number": "1053511394",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8736 S 50TH AVE",
            "city": "OAK LAWN",
            "state": "IL",
            "postal_code": "604531340",
            "telephone_number": "847-454-4046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3001 A 6TH ST",
            "city": "GREAT LAKES",
            "state": "IL",
            "postal_code": "60088",
            "telephone_number": "847-688-4560"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDSBOROUGH",
        "first_name": "EDWARD",
        "middle_name": "NMN",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "credential": "IDC",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-07-24",
        "last_updated": "2007-07-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1710I1002X",
            "taxonomy_group": "",
            "desc": "Military Health Care Provider, Independent Duty Corpsman",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gerald J. George, R.PH.
• Richard E Gerhardt, D.D.S.
• Saman Reza Gharib, DMD
• Mark David Gilberts, DDS
• Kathy Sue Gluzinski, RPH
• Eric Martin Gomez, M.D.
• Chase James Gottschalk, DDS
• Martin Louis Gottstine, DDS
• David Lawrence Green, D.D.S.
• Sang Soo John Grzesik, DDS

• Independent Duty Corpsman in Great Lakes, IL
• Providers in Great Lakes, IL by specialty
• Independent Duty Corpsman in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.