Individual
MELVIN J GOLDSTEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
676 N SAINT CLAIR ST, SUITE 1525, CHICAGO, IL 60611-2927
(312) 337-1556
(312) 266-0478
Mailing address
PO BOX 388320, CHICAGO, IL 60638-8320
(773) 767-8283
(773) 767-8320
Taxonomy
Speciality
Code
Description
License number
State
207RG0100X
Gastroenterology Physician
Primary
036038943
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036038943
—
IL
01
—
111528598
RAILROAD MEDICARE
—
01
—
21601042
BLUE SHIELD
IL
Enumeration date
10/12/2005
Last updated
08/26/2009
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