Healthcare Provider Details

I. General information

NPI: 1003896374
Provider Name (Legal Business Name): JACOB B. GOLDSTEIN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/20/2006
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 S CLAIRBORNE RD STE 201
OLATHE KS
66062-1735
US

IV. Provider business mailing address

401 S CLAIRBORNE RD STE 201
OLATHE KS
66062-1735
US

V. Phone/Fax

Practice location:
  • Phone: 913-856-8150
  • Fax: 913-856-8390
Mailing address:
  • Phone: 913-856-8150
  • Fax: 913-856-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number12-00358KS
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberMD2185
License Number StateNJ
# 3
Primary TaxonomyN
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number2006023557
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: