J I Goldman MD PC

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

036100764 Issued in IL

Legal business name

J I GOLDMAN MD PC

Practice address

4646 N Marine Dr
B 125
Chicago, IL 60640-5759

Phone

(773) 572-0032

Fax

(773) 572-0029

NPI assigned

Mar 30, 2007

Organization subpart

No

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

Authorized official

Name

Jaroslav Goldman, M,D,

Title

President

Phone

(312) 787-4916

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1175212800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1260921600000",
    "number": "1144340308",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 W ONTARIO ST APT 36B",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606547771",
            "telephone_number": "312-787-4916"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4646 N MARINE DR",
            "address_2": "B 125",
            "city": "CHICAGO",
            "state": "IL",
            "postal_code": "606405759",
            "telephone_number": "773-572-0032",
            "fax_number": "773-572-0029"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "J I GOLDMAN MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-03-30",
        "last_updated": "2009-12-16",
        "status": "A",
        "authorized_official_last_name": "GOLDMAN",
        "authorized_official_first_name": "JAROSLAV",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "312-787-4916",
        "authorized_official_credential": "M,D,"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": "IL",
            "license": "036100764",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "036100764",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Internal Medicine Physician in Chicago, IL
• Providers in Chicago, IL by specialty
• Internal Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2009; 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.