Provider Demographics
NPI:1972639110
Name:GOLDSTEIN, JONATHAN WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:WILLIAM
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-895-8970
Mailing Address - Fax:502-895-8971
Practice Address - Street 1:3920 DUTCHMANS LN
Practice Address - Street 2:SUITE 300
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4702
Practice Address - Country:US
Practice Address - Phone:502-895-8970
Practice Address - Fax:502-895-8971
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-24
Last Update Date:2016-09-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY38859207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64115033 (KOHMG)Medicaid
KY64115033 (KOHMG)Medicaid
KYP01589547 RR (KOHMG)Medicare PIN