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MITCHELL R GOLDSTEIN MD NPI 1700196698


NPI Information

NPI: 1700196698
Provider Name: MITCHELL R GOLDSTEIN, MD
Classification: Counselor - 101YP2500X
Entity Type: Organization

Specialization: Professional

Address:
107 N EDDY ST
SOUTH BEND, IN
ZIP 46617
Phone: (574) 532-0153
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MITCHELL R GOLDSTEIN, MD is a professional counselor in South Bend, IN. MITCHELL R GOLDSTEIN, MD NPI is 1700196698. The provider is registered as an organization entity type.

The provider's business location address is:

107 N EDDY ST
SOUTH BEND, IN
ZIP 46617-920
Phone: (574) 532-0153
Fax: (574) 246-1634

The provider's authorized official is Mitchell Robert Goldstein .
The authorized official title is Owner and has the following contact phone number (574) 532-0153.

The enumeration date for this NPI number is 10/14/2010 and was last updated on 10/18/2010.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1251S00000XCommunity/Behavioral HealthNo
2101YP2500XCounselorProfessionalYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1100346980BMEDICAIDINDIANA
2183980MEDICARE PIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.