1730413394 NPI number — KLEIN MEDICAL PC

Table of content: (NPI 1730413394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730413394 NPI number — KLEIN MEDICAL PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KLEIN MEDICAL PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY OCCUPATIONAL MEDICINE
Provider Other Organization Name Type Code:
3
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:
1730413394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1131 N OSSEO RD
Provider Second Line Business Mailing Address:
PO BOX 187
Provider Business Mailing Address City Name:
HILLSDALE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49242-9714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
517-523-3695
Provider Business Mailing Address Fax Number:
517-523-3311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
370 E CHICAGO ST
Provider Second Line Business Practice Location Address:
SUITE 700
Provider Business Practice Location Address City Name:
COLDWATER
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49036-2062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
517-279-5099
Provider Business Practice Location Address Fax Number:
517-279-5097
Provider Enumeration Date:
09/29/2009

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
517-279-5099

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  4301060120 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1730413394 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1730413394 . This is a "BCBSM" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




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