Provider Demographics
NPI:1366585614
Name:SALMON S GOLDBERG MD AND DAVID S CHUDWIN MDSC
Entity type:Organization
Organization Name:SALMON S GOLDBERG MD AND DAVID S CHUDWIN MDSC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:S
Authorized Official - Last Name:CHUDWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-272-4296
Mailing Address - Street 1:500 SKOKIE BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-2856
Mailing Address - Country:US
Mailing Address - Phone:847-272-4296
Mailing Address - Fax:847-272-4177
Practice Address - Street 1:500 SKOKIE BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062-2856
Practice Address - Country:US
Practice Address - Phone:847-272-4296
Practice Address - Fax:847-272-4177
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2007-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210645Medicare PIN
IL900770Medicare PIN
IL269800Medicare PIN