Provider Demographics
NPI:1225183452
Name:LEE H. GOLDSTEIN DPM PSC
Entity type:Organization
Organization Name:LEE H. GOLDSTEIN DPM PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEE
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:GOLDSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:270-684-1660
Mailing Address - Street 1:509 E 18TH ST
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-3849
Mailing Address - Country:US
Mailing Address - Phone:270-684-1660
Mailing Address - Fax:270-684-5014
Practice Address - Street 1:509 E 18TH ST
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-3849
Practice Address - Country:US
Practice Address - Phone:270-684-1660
Practice Address - Fax:270-684-5014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY162213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000052142OtherANTHEM
KY000000052142OtherANTHEM
KY2007301Medicare ID - Type Unspecified