Provider Demographics
NPI:1912096710
Name:GOLDSTEIN, HEIDI JANE (MD)
Entity Type:Individual
Prefix:
First Name:HEIDI
Middle Name:JANE
Last Name:GOLDSTEIN
Suffix:
Gender:F
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:CHILDRENS SPECIALTY CLINICS
Mailing Address - Street 2:2525 CHICAGO AVENUE S
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404
Mailing Address - Country:US
Mailing Address - Phone:612-343-2121
Mailing Address - Fax:
Practice Address - Street 1:CHILDRENS HEALTH CARE
Practice Address - Street 2:345 NORTH SMITH AVE
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55102
Practice Address - Country:US
Practice Address - Phone:612-343-2121
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN604462081P0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPediatric Rehabilitation Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14161Medicaid
ND27721OtherBCBS
NDP00441729OtherRAILROAD MEDICARE
ND27721OtherBCBS
NDN715281Medicare PIN
ND14161Medicaid
NDN716138Medicare PIN