Provider Demographics
NPI:1649240565
Name:GOLDMAN, JULIE L (MD)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:L
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S FLOYD ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202
Mailing Address - Country:US
Mailing Address - Phone:502-583-8303
Mailing Address - Fax:502-583-2938
Practice Address - Street 1:601 S FLOYD ST
Practice Address - Street 2:SUITE 700
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202
Practice Address - Country:US
Practice Address - Phone:502-583-8303
Practice Address - Fax:502-583-2938
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2007-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY24684207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64246846Medicaid
KY1051212OtherPASSPORT
C72346Medicare UPIN
KY1051212OtherPASSPORT