1639213580 NPI number — DR. LAURA L KLEIN MD

Table of content: DR. LAURA L KLEIN MD (NPI 1639213580)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639213580 NPI number — DR. LAURA L KLEIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEIN
Provider First Name:
LAURA
Provider Middle Name:
L
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LACROIX
Provider Other First Name:
LAURA
Provider Other Middle Name:
MARINA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639213580
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8890 N UNION BLVD STE 160
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COLORADO SPRINGS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80920-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-365-9950
Provider Business Mailing Address Fax Number:
719-365-9969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 E BOULDER ST
Provider Second Line Business Practice Location Address:
MEMORIAL MATERNAL FETAL MEDICINE
Provider Business Practice Location Address City Name:
COLORADO SPRINGS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80909-5533
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
719-365-5960
Provider Business Practice Location Address Fax Number:
719-365-5977
Provider Enumeration Date:
02/16/2007

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: 207VM0101X , with the licence number:  40757 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 48704563 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".