Provider Demographics
NPI:1508868845
Name:GOLDSTEIN, MICHAEL LEE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LEE
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:16820 FRANCES ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68130
Mailing Address - Country:US
Mailing Address - Phone:402-933-6600
Mailing Address - Fax:402-933-7123
Practice Address - Street 1:16820 FRANCES ST
Practice Address - Street 2:SUITE 100
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68130
Practice Address - Country:US
Practice Address - Phone:402-933-6600
Practice Address - Fax:402-933-7123
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-02-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE17741207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10025058900Medicaid
NE10025802200Medicaid
IA3956896Medicaid
NE10025058900Medicaid
NE10025802200Medicaid
IA3956896Medicaid