Healthcare Provider Details

I. General information

NPI: 1912096710
Provider Name (Legal Business Name): HEIDI JANE GOLDSTEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDRENS HEALTH CARE 345 NORTH SMITH AVE
ST PAUL MN
55102
US

IV. Provider business mailing address

CHILDRENS SPECIALTY CLINICS 2525 CHICAGO AVENUE S
MINNEAPOLIS MN
55404
US

V. Phone/Fax

Practice location:
  • Phone: 612-343-2121
  • Fax:
Mailing address:
  • Phone: 612-343-2121
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P0010X
TaxonomyPediatric Rehabilitation Medicine Physician
License Number60446
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: