Basic Information
| Provider Information | |||||||||
| NPI: | 1295154052 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GOLDSTEIN | ||||||||
| FirstName: | JEFFERY | ||||||||
| MiddleName: | ADAM | ||||||||
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| Credential: | PHD, MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 680 N LAKE SHORE DR | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606114546 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3126956868 | ||||||||
| FaxNumber: | 6153220576 | ||||||||
| Practice Location | |||||||||
| Address1: | 303 EAST CHICAGO AVE | ||||||||
| Address2: | WARD 3-140 W127 | ||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 60611 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3125038144 | ||||||||
| FaxNumber: | 3125038249 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2014 | ||||||||
| LastUpdateDate: | 04/10/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZP0101X | 036141694 | IL | Y | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology |
No ID Information.