Provider Demographics
NPI:1770768442
Name:GOLDHIRSH, BENJAMIN STUART
Entity type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:STUART
Last Name:GOLDHIRSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 S WOLCOTT AVE
Mailing Address - Street 2:M/C 844
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3748
Mailing Address - Country:US
Mailing Address - Phone:312-224-8461
Mailing Address - Fax:312-277-9575
Practice Address - Street 1:835 S WOLCOTT AVE
Practice Address - Street 2:M/C 844
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3748
Practice Address - Country:US
Practice Address - Phone:312-224-8461
Practice Address - Fax:312-277-9575
Is Sole Proprietor?:No
Enumeration Date:2007-12-31
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor