MEDICARE: DR. RACHEL A GOLDSTEIN DO

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	207PE0004X	Emergency Medical Services (Emergency Medicine) Physician	5101014818	MI
2	207PE0005X	Undersea and Hyperbaric Medicine (Emergency Medicine) Physician	036-113780	IL
3	207P00000X	Emergency Medicine Physician	036-113780	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	RG014818	OTHER	MI	BC/BS OF MICHIGAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346287521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RACHEL A GOLDSTEIN DO

Provider Business Mailing Address
First Line	:	1628 N BOSWORTH AVE
Second Line	:	#1
City	:	CHICAGO
State	:	IL
Zip	:	60642-1417
Country	:	US
Telephone Number	:	248-376-5679
Fax Number	:

Provider Business Practice Location Address
First Line	:	1628 N BOSWORTH AVE
Second Line	:	#1
City	:	CHICAGO
State	:	IL
Zip	:	60622-1417
Country	:	US
Telephone Number	:	248-376-5679
Fax Number	:

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	07/30/2010

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