Provider Demographics
NPI:1922060623
Name:LEE H. GOLDSTEIN DPM PSC
Entity Type:Organization
Organization Name:LEE H. GOLDSTEIN DPM PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:502-339-1200
Mailing Address - Street 1:8062 NEW LAGRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4764
Mailing Address - Country:US
Mailing Address - Phone:502-339-1200
Mailing Address - Fax:502-339-9493
Practice Address - Street 1:8062 NEW LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4764
Practice Address - Country:US
Practice Address - Phone:502-339-1200
Practice Address - Fax:502-339-9493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-06
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY162213E00000X
IN517-B213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000052143OtherANTHEM
KYT78546Medicare UPIN
KY000000052143OtherANTHEM
KY2007302Medicare ID - Type Unspecified