Provider Demographics
NPI:1619237609
Name:GOLDSTEIN, STEPHANIE (MD)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1500 E. MEDICAL CENTER DRIVE
Mailing Address - Street 2:D3236 MPB
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48109-5718
Mailing Address - Country:US
Mailing Address - Phone:734-763-5589
Mailing Address - Fax:734-763-4208
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:L1242 WOMENS/5204
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-5000
Practice Address - Country:US
Practice Address - Phone:734-936-4038
Practice Address - Fax:734-936-9470
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2021-12-17
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Provider Licenses
StateLicense IDTaxonomies
MI4301100741208000000X
UT11690486-12052080P0203X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics