Provider Demographics
NPI:1437158391
Name:GOLDSTEIN, CRAIG A (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:A
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:PO BOX 871248
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64187-1248
Mailing Address - Country:US
Mailing Address - Phone:913-322-6675
Mailing Address - Fax:
Practice Address - Street 1:8701 TROOST AVE
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131-2767
Practice Address - Country:US
Practice Address - Phone:913-322-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOD0161122207P00000X
MODO161122207PE0004X
MO2000161122207PE0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
29257015OtherBLUE CROSS BLUE SHIELD
KS100403850AMedicaid
MO245336706Medicaid
MO356A972Medicare ID - Type Unspecified
KS100403850AMedicaid