Provider Demographics
NPI:1356306609
Name:GOLDSTEIN, STEVEN J (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 950202
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40295-0202
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:2051 CLEVIDENCE BLVD
Practice Address - Street 2:STE. 1
Practice Address - City:CLARKSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47129-2278
Practice Address - Country:US
Practice Address - Phone:812-280-9145
Practice Address - Fax:812-280-6627
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041381A207R00000X
KY29515207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00711460OtherRAILROAD MEDICARE - KY
KY00000050979OtherANTHEM / NCMA
IN110138273OtherRAILROAD MEDICARE
KY64124845Medicaid
KY000023031COtherHUMANA / NCMA
KY004347OtherSIHO / NCMA
KY2447475000OtherPASSPORT ADVANTAGE / NCMA
IN100077580Medicaid
KY1193979OtherCHA / NCMA
KY2561692OtherCIGNA / NCMA
KY50006207OtherPASSPORT / NCMA
KY004347OtherSIHO / NCMA
KYP00711460OtherRAILROAD MEDICARE - KY
KY00000050979OtherANTHEM / NCMA