1780624320 NPI number — DR. NARESH C GOEL M.D.

Table of content: DR. NARESH C GOEL M.D. (NPI 1780624320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780624320 NPI number — DR. NARESH C GOEL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOEL
Provider First Name:
NARESH
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1780624320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
707 N LOGAN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DANVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61832-4360
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-477-4768
Provider Business Mailing Address Fax Number:
217-477-4754

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
707 N LOGAN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DANVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61832-4360
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-477-4768
Provider Business Practice Location Address Fax Number:
217-477-4754
Provider Enumeration Date:
06/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X , with the licence number:  36060753 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 172066 . This is a "PERSONAL CARE/COVENTRY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 371181230 . This is a "HEALTH ALLIANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 371181230 . This is a "PREFERRED PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1373293 . This is a "UNITED MINE WORKERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 09232006 . This is a "BCBS OF ILLINOIS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 371181230 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 371181230 . This is a "BEECHSTREET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 371181230 . This is a "HFN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 371181230 . This is a "TRICARE/CHAMPUS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100014850 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 247879 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".




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