Provider Demographics
NPI:1114962248
Name:GOLDIN, STEVEN BRADLEY (MD PHD MPH CPH)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:BRADLEY
Last Name:GOLDIN
Suffix:
Gender:M
Credentials:MD PHD MPH CPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 735044
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60673-5044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5300 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TWO RIVERS
Practice Address - State:WI
Practice Address - Zip Code:54241-3923
Practice Address - Country:US
Practice Address - Phone:920-793-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2023-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLD50663208600000X, 2086X0206X
WI82540208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL998104OtherWELLCARE
FLP01343444OtherRR MEDICARE
WI100252615Medicaid
MD261943100Medicaid
FL7685148OtherAETNA
FLP04478OtherFREEDOM
FLP01342438OtherRR MEDICARE
FLP203601OtherOPTIMUM
FLP203601OtherOPTIMUM
MD261943100Medicaid