Provider Demographics
NPI:1083722219
Name:GOLDSTEIN, STEVEN I (DO)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:I
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 57TH PL
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-6397
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1300 37TH ST STE 3
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-1900
Practice Address - Country:US
Practice Address - Phone:515-220-2081
Practice Address - Fax:833-985-2171
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-28
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02791208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1083722219Medicaid
IA6169896Medicaid
IAF70614Medicare UPIN