Provider Demographics
NPI:1285691055
Name:GOLDSTEIN, LUDMILA (MD)
Entity type:Individual
Prefix:DR
First Name:LUDMILA
Middle Name:
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 1:8620 S. TAMIAMI TRAIL
Mailing Address - Street 2:SUITE F-G
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34238-3049
Mailing Address - Country:US
Mailing Address - Phone:941-966-4949
Mailing Address - Fax:941-966-2489
Practice Address - Street 1:8620 S. TAMIAMI TRAIL
Practice Address - Street 2:SUITE F-G
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-3049
Practice Address - Country:US
Practice Address - Phone:941-966-4949
Practice Address - Fax:941-966-2489
Is Sole Proprietor?:No
Enumeration Date:2006-04-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT036795207Q00000X
FLME107583207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME107583OtherMEDICAL LICENSE
CT001367954Medicaid
CT036795OtherMEDICAL LICENSE
CT036795OtherMEDICAL LICENSE
CT001367954Medicaid