Provider Demographics
NPI:1295154052
Name:GOLDSTEIN, JEFFERY ADAM (PHD, MD)
Entity type:Individual
Prefix:
First Name:JEFFERY
Middle Name:ADAM
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:PHD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-695-6868
Mailing Address - Fax:615-322-0576
Practice Address - Street 1:303 EAST CHICAGO AVE
Practice Address - Street 2:WARD 3-140 W127
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611
Practice Address - Country:US
Practice Address - Phone:312-503-8144
Practice Address - Fax:312-503-8249
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036141694207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology