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General NPI Number Information
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NPI Number | 1376531400
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Entity Type | Individual
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Provider Name | MELVIN J GOLDSTEIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 10/12/2005
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Last Update Date | 08/26/2009
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Provider Practice Location Address
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Address Line | 676 N SAINT CLAIR ST SUITE 1525
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City | CHICAGO
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State | IL
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Zip | 60611-2927
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Country | US
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Telephone | 312-337-1556
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Fax | 312-266-0478
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Provider Business Mailing Address
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Address Line | PO BOX 388320
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City | CHICAGO
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State | IL
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Zip | 60638-8320
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Country | US
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Telephone | 773-767-8283
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Fax | 773-767-8320
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | 036038943
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License Number State | IL
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