Daniel Edward Goldenberg, MD | |
530 Ne Glen Oak Ave, Peoria, IL 61637 | |
(309) 655-2274 | |
(309) 655-2565 |
Full Name | Daniel Edward Goldenberg |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 530 Ne Glen Oak Ave, Peoria, Illinois |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1295226132 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 036168592 (Illinois) | Primary |
Entity Name | Ssm Health Care St Louis |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1275586174 PECOS PAC ID: 7810800737 Enrollment ID: O20031118000393 |
Entity Name | Ssm Cardinal Glennon Children's Hospital |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1174577670 PECOS PAC ID: 7012828163 Enrollment ID: O20031231000604 |
Entity Name | Citizens Memorial Healthcare |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1568566131 PECOS PAC ID: 4183528169 Enrollment ID: O20040315001374 |
Mailing Address | Practice Location Address |
---|---|
Daniel Edward Goldenberg, MD 530 Ne Glen Oak Ave, Peoria, IL 61637-0001 Ph: (386) 882-2715 | Daniel Edward Goldenberg, MD 530 Ne Glen Oak Ave, Peoria, IL 61637 Ph: (309) 655-2274 |
Thomas James Mcmorrow, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2553 Fax: 309-655-2602 | |
Jessica Ford-davis, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2274 | |
Kelsey Elizabeth Grimes, DO Pediatrics Medicare: Not Enrolled in Medicare Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000 | |
Jessica N Mistretta, DO Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-2000 | |
Mrs. Valeria Claudia Benavides Lopez, M.D., M.P.H. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-624-3313 | |
Khalid Al Katranji, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-655-7171 | |
Dr. Gretchen L Kopec, M.D. Pediatrics Medicare: Medicare Enrolled Practice Location: 530 Ne Glen Oak Ave, Peoria, IL 61637 Phone: 309-624-0615 |