Provider Demographics
NPI:1700802295
Name:GOLDSTEIN, RANDALL AARON (DO)
Entity Type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:AARON
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:RANDALL
Other - Middle Name:AARON
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:6301 N LUCERNE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64151-3105
Mailing Address - Country:US
Mailing Address - Phone:816-569-1802
Mailing Address - Fax:816-569-1882
Practice Address - Street 1:6301 N LUCERNE AVE
Practice Address - Street 2:MOSAIC LIFE CARE AT BURLINGTON CREEK
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-3105
Practice Address - Country:US
Practice Address - Phone:816-387-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2017-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS29058208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1700802295Medicaid
MO1700802295Medicaid
KSH55521Medicare UPIN