Provider Demographics
NPI:1053380907
Name:GOLDIN, YULY (MD)
Entity type:Individual
Prefix:
First Name:YULY
Middle Name:
Last Name:GOLDIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 KENYON RD
Mailing Address - Street 2:SUITE H
Mailing Address - City:FORT DODGE
Mailing Address - State:IA
Mailing Address - Zip Code:50501-5742
Mailing Address - Country:US
Mailing Address - Phone:515-955-3370
Mailing Address - Fax:515-576-5659
Practice Address - Street 1:804 KENYON RD
Practice Address - Street 2:SUITE H
Practice Address - City:FORT DODGE
Practice Address - State:IA
Practice Address - Zip Code:50501-5742
Practice Address - Country:US
Practice Address - Phone:515-955-3370
Practice Address - Fax:515-576-5659
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2010-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA27222208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0275503Medicaid
IA340004864OtherRAILROAD MEDICARE
IA4409OtherMIDLAND'S CHOICE
IA27550Medicare ID - Type Unspecified
IA0275503Medicaid