Provider Demographics
NPI:1447363627
Name:GOLDSTEIN, STEVE AN (MD, PHD)
Entity type:Individual
Prefix:DR
First Name:STEVE
Middle Name:AN
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5841 S MARYLAND AVE
Mailing Address - Street 2:SUITE K-160G - MC 8000
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60637-1447
Mailing Address - Country:US
Mailing Address - Phone:773-702-6205
Mailing Address - Fax:773-702-4523
Practice Address - Street 1:5841 S MARYLAND AVE
Practice Address - Street 2:SUITE K-160G - MC 8000
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60637-1447
Practice Address - Country:US
Practice Address - Phone:773-702-6205
Practice Address - Fax:773-702-4523
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
F97430Medicare UPIN