Provider Demographics
NPI:1578523643
Name:GOLDSTEIN, NEAL STEWART (MD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:STEWART
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 COLUMBIA
Mailing Address - Street 2:
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-1460
Mailing Address - Country:US
Mailing Address - Phone:248-499-0156
Mailing Address - Fax:
Practice Address - Street 1:6455 MISSION COURT
Practice Address - Street 2:
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-1399
Practice Address - Country:US
Practice Address - Phone:313-486-9008
Practice Address - Fax:313-486-9044
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301064488207ZP0102X
CAG63732207ZP0102X
MI23D2013964207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI220F362370OtherBCBSM
MI3076209Medicaid
MI3076209Medicaid
MIF73242Medicare UPIN