MEDICARE: LEE H. GOLDSTEIN DPM PSC

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	213E00000X	Podiatrist	517-B	IN
2	213E00000X	Podiatrist	162	KY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000052143	OTHER	KY	ANTHEM

General Provider Information

NPI Number	:	1922060623
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEE H. GOLDSTEIN DPM PSC

Provider Business Mailing Address
First Line	:	8062 NEW LAGRANGE RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-4764
Country	:	US
Telephone Number	:	502-339-1200
Fax Number	:	502-339-9493

Provider Business Practice Location Address
First Line	:	8062 NEW LAGRANGE RD
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40222-4764
Country	:	US
Telephone Number	:	502-339-1200
Fax Number	:	502-339-9493

Authorized Official
Title or Position	:	OWNER
Name	:	DR. LEE HOWARD GOLDSTEIN
Credential	:	D.P.M.
Telephone Number	:	502-339-1200

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	02/25/2008

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