Addiction Wellness Services Inc

Primary specialty

Pediatric Anesthesiology PhysicianTaxonomy code 207LP3000X

License

MD438154 Issued in PA

Legal business name

ADDICTION WELLNESS SERVICES INC

Practice address

5504 N 2ND St
Loves Park, IL 61111-5013

Phone

(815) 997-4516

NPI assigned

Nov 22, 2017

Organization subpart

No

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

Authorized official

Name

Dr. Gagandeep Goyal, MD

Title

President

Phone

(267) 226-4760

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1511308800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1548720000000",
    "number": "1467966853",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3824 NORTHERN PIKE STE 600",
            "city": "MONROEVILLE",
            "state": "PA",
            "postal_code": "151462156",
            "telephone_number": "412-457-0175",
            "fax_number": "412-457-0179"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5504 N 2ND ST",
            "city": "LOVES PARK",
            "state": "IL",
            "postal_code": "611115013",
            "telephone_number": "815-997-4516"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ADDICTION WELLNESS SERVICES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-22",
        "last_updated": "2019-01-29",
        "status": "A",
        "authorized_official_last_name": "GOYAL",
        "authorized_official_first_name": "GAGANDEEP",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "267-226-4760",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP3000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pediatric Anesthesiology",
            "state": "PA",
            "license": "MD438154",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PA LICENSE",
            "identifier": "MD438154",
            "state": "PA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "IL LICENSE",
            "identifier": "036144684",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• All providers in Loves Park, IL
• Pediatric Anesthesiology Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 29, 2019; 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.