Provider Demographics
NPI:1700802295
Name:GOLDSTEIN, RANDALL AARON (DO)
Entity type:Individual
Prefix:DR
First Name:RANDALL
Middle Name:AARON
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:RANDALL
Other - Middle Name:AARON
Other - Last Name:GOLDSTEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:2111 E KANSAS CITY RD
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7050
Mailing Address - Country:US
Mailing Address - Phone:913-220-5724
Mailing Address - Fax:913-222-1907
Practice Address - Street 1:2111 E KANSAS CITY RD
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66061-7050
Practice Address - Country:US
Practice Address - Phone:913-220-5724
Practice Address - Fax:913-222-1907
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS29058208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1700802295Medicaid
MO1700802295Medicaid
KSH55521Medicare UPIN