Provider Demographics
NPI:1598756827
Name:GOLDYN, JAMES L (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:L
Last Name:GOLDYN
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 1:9660 WICKER AVE
Mailing Address - Street 2:
Mailing Address - City:ST JOHN
Mailing Address - State:IN
Mailing Address - Zip Code:46373-9487
Mailing Address - Country:US
Mailing Address - Phone:219-844-9060
Mailing Address - Fax:219-844-6912
Practice Address - Street 1:3432-169TH STR
Practice Address - Street 2:
Practice Address - City:HAMMOND
Practice Address - State:IN
Practice Address - Zip Code:46323-2542
Practice Address - Country:US
Practice Address - Phone:219-844-9060
Practice Address - Fax:219-844-6912
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024860208000000X
IN01024860A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100169810AMedicaid
IN100169810AMedicaid
408110CMedicare ID - Type Unspecified
C25255Medicare UPIN