Provider Demographics
NPI:1255347811
Name:GOOMAR, PRITH M (MD)
Entity type:Individual
Prefix:DR
First Name:PRITH
Middle Name:M
Last Name:GOOMAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:5875 N LINCOLN AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4672
Mailing Address - Country:US
Mailing Address - Phone:312-446-8785
Mailing Address - Fax:773-890-1199
Practice Address - Street 1:5875 N LINCOLN AVE STE 105
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4672
Practice Address - Country:US
Practice Address - Phone:312-446-8785
Practice Address - Fax:773-890-1199
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036077049207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077049Medicaid
IL215070Medicare ID - Type Unspecified