Provider Demographics
NPI:1871646554
Name:GOLDSTEIN, A SANDOR (MD)
Entity Type:Individual
Prefix:
First Name:A
Middle Name:SANDOR
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 1:1000 MINERAL POINT AVE
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:WI
Mailing Address - Zip Code:53548-2940
Mailing Address - Country:US
Mailing Address - Phone:608-756-6868
Mailing Address - Fax:608-756-6289
Practice Address - Street 1:1000 MINERAL POINT AVE
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:WI
Practice Address - Zip Code:53548-2940
Practice Address - Country:US
Practice Address - Phone:608-756-6868
Practice Address - Fax:608-756-6289
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2012-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI302102086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIGOLDSASAOtherMERCYCARE INSURANCE
WIP00995128DB7792OtherRR MEDICARE
WI1871646554Medicaid
WI31481700Medicaid
WIGOLDSASAOtherMERCYCARE INSURANCE
E04638Medicare UPIN
WI002190288Medicare PIN