MEDICARE: DR. JAMES L GOLDYN MD

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	208000000X	Pediatrics Physician	01024860	IN
2	208000000X	Pediatrics Physician	01024860A	IN

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	:	1598756827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES L GOLDYN MD

Provider Business Mailing Address
First Line	:	9660 WICKER AVE
Second Line	:
City	:	ST JOHN
State	:	IN
Zip	:	46373-9487
Country	:	US
Telephone Number	:	219-844-9060
Fax Number	:	219-844-6912

Provider Business Practice Location Address
First Line	:	3432-169TH STR
Second Line	:
City	:	HAMMOND
State	:	IN
Zip	:	46323-2542
Country	:	US
Telephone Number	:	219-844-9060
Fax Number	:	219-844-6912

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

Provider Enumeration Date	:	11/04/2005
Last Update Date	:	11/09/2011

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