Provider Demographics
NPI:1982742789
Name:DR JOSEPH B GOLDSTEIN SC
Entity Type:Organization
Organization Name:DR JOSEPH B GOLDSTEIN SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:B
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:847-824-1022
Mailing Address - Street 1:1556 S RIVER ROAD
Mailing Address - Street 2:
Mailing Address - City:DES PLAINES
Mailing Address - State:IL
Mailing Address - Zip Code:60018-1743
Mailing Address - Country:US
Mailing Address - Phone:847-824-1022
Mailing Address - Fax:847-824-5971
Practice Address - Street 1:1556 S RIVER ROAD
Practice Address - Street 2:
Practice Address - City:DES PLAINES
Practice Address - State:IL
Practice Address - Zip Code:60018-1743
Practice Address - Country:US
Practice Address - Phone:847-824-1022
Practice Address - Fax:847-824-5971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036052069207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036052069Medicaid
IL0021606387OtherBCBS
IL0021609251OtherBCBS
IL036052069Medicaid
IL488560Medicare ID - Type Unspecified
IL488563Medicare ID - Type Unspecified