MEDICARE: MITCHELL E GOLDSTEIN D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS0004093	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568468445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MITCHELL E GOLDSTEIN D.O.

Provider Business Mailing Address
First Line	:	ASSOCIATED FAMILY PHYSICIANS OF BOCA RATON, P.L.
Second Line	:	9910 SANDALFOOT BLVD., SUITE 1
City	:	BOCA RATON
State	:	FL
Zip	:	33428-6692
Country	:	US
Telephone Number	:	561-883-3030
Fax Number	:	561-852-7611

Provider Business Practice Location Address
First Line	:	9970 CENTRAL PARK BLVD N STE 400
Second Line	:
City	:	BOCA RATON
State	:	FL
Zip	:	33428-2236
Country	:	US
Telephone Number	:	561-487-7931
Fax Number	:	561-487-1204

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/24/2005
Last Update Date	:	04/24/2019

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