1033157334 NPI number — DR. LYNDA Z KLEIMAN M.D.

Table of content: DR. LYNDA Z KLEIMAN M.D. (NPI 1033157334)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033157334 NPI number — DR. LYNDA Z KLEIMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEIMAN
Provider First Name:
LYNDA
Provider Middle Name:
Z
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033157334
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1033 DR MARTIN LUTHER KING JR ST N
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
ST PETERSBURG
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33701-1547
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-456-4250
Provider Business Mailing Address Fax Number:
727-346-1044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
790 CONCOURSE PKWY S STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MAITLAND
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32751
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
407-767-6411
Provider Business Practice Location Address Fax Number:
407-767-8160
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  ME99124 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207WX0120X , with the licence number: ME99124 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 001300900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: CH765Z . This is a "MEDICARE PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 001300900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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