Provider Demographics
NPI:1639235765
Name:GOLDSTEIN, KEITH (DPM)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4649 GARDENS PARK BLVD APT 3308
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-2623
Mailing Address - Country:US
Mailing Address - Phone:407-509-8852
Mailing Address - Fax:
Practice Address - Street 1:4649 GARDENS PARK BLVD APT 3308
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-2623
Practice Address - Country:US
Practice Address - Phone:407-509-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2021-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2436213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2701686OtherEVERCARE
FL340109000Medicaid
FL2701686OtherEVERCARE
FL340109000Medicaid
U80456Medicare UPIN