Provider Demographics
NPI:1568468445
Name:GOLDSTEIN, MITCHELL E (DO)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:E
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:ASSOCIATED FAMILY PHYSICIANS OF BOCA RATON, P.L.
Mailing Address - Street 2:9910 SANDALFOOT BLVD., SUITE 1
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-6692
Mailing Address - Country:US
Mailing Address - Phone:561-883-3030
Mailing Address - Fax:561-852-7611
Practice Address - Street 1:9970 CENTRAL PARK BLVD N STE 400
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2236
Practice Address - Country:US
Practice Address - Phone:561-487-7931
Practice Address - Fax:561-487-1204
Is Sole Proprietor?:No
Enumeration Date:2005-06-24
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0004093207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL82350ZMedicare PIN
E32214Medicare UPIN