Individual
DR. MITCHELL ROBERT GOLDSTEIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
107 N EDDY ST, SOUTH BEND, IN 46617-2920
(574) 246-1036
(574) 246-1634
Mailing address
107 N EDDY ST, SOUTH BEND, IN 46617-2920
(574) 246-1036
(574) 246-1634
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
01041575
IN
2084P0804X
Child & Adolescent Psychiatry Physician
Primary
01041575
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100346980A
—
IN
05
—
100346980B
—
IN
Enumeration date
04/14/2006
Last updated
11/25/2020
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