| Mitchell R Goldstein, Md | |
|
107 N Eddy St South Bend IN 46617-2920 | |
| (574) 532-0153 | |
| (574) 246-1634 |
| Full Name | Mitchell R Goldstein, Md |
|---|---|
| Speciality | Counselor - Professional |
| Location | 107 N Eddy St, South Bend, Indiana |
| Authorized Official Name and Position | Mitchell Robert Goldstein (OWNER) |
| Authorized Official Contact | 5745320153 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Mitchell R Goldstein, Md 107 N Eddy St South Bend IN 46617-2920 Ph: (574) 532-0153 | Mitchell R Goldstein, Md 107 N Eddy St South Bend IN 46617-2920 Ph: (574) 532-0153 |
| NPI Number | 1700196698 |
|---|---|
| Provider Enumeration Date | 10/14/2010 |
| Last Update Date | 10/18/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700196698 | NPI | - | NPPES |
| 100346980B | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YP2500X | Counselor - Professional | (* (Not Available)) | Primary |
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Secondary |
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