Provider Demographics
NPI:1215905682
Name:GOLDSTEIN, LEE H (DPM)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:H
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:LEE
Other - Middle Name:H
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM PSC
Mailing Address - Street 1:8062 NEW LAGRANGE ROAD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3849
Mailing Address - Country:US
Mailing Address - Phone:505-339-1200
Mailing Address - Fax:502-339-9493
Practice Address - Street 1:8062 NEW LAGRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3849
Practice Address - Country:US
Practice Address - Phone:505-339-1200
Practice Address - Fax:502-339-9493
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-10
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY162213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1075808OtherPASSPORT HEALTH
KY000000052142OtherANTHEM BC/BS
KY480027177OtherRAILROAD MEDICARE
KY3552089OtherHEALTHSTAR
INT78546Medicare UPIN
KY000000052142OtherANTHEM BC/BS
KY2007301Medicare ID - Type UnspecifiedOWENSBORO OFFICE
KY480027177OtherRAILROAD MEDICARE