1770679987 NPI number — ROBERT J KLEIN DO

Table of content: ROBERT J KLEIN DO (NPI 1770679987)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770679987 NPI number — ROBERT J KLEIN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEIN
Provider First Name:
ROBERT
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

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:
1770679987
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1652 42ND ST NE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
CEDAR RAPIDS
Provider Business Mailing Address State Name:
IA
Provider Business Mailing Address Postal Code:
52402-3075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
319-395-0223
Provider Business Mailing Address Fax Number:
319-395-7832

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1652 42ND ST NE
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
CEDAR RAPIDS
Provider Business Practice Location Address State Name:
IA
Provider Business Practice Location Address Postal Code:
52402-3075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
319-395-0223
Provider Business Practice Location Address Fax Number:
319-395-7832
Provider Enumeration Date:
10/05/2006

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: 204D00000X , with the licence number:  02045 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 204D00000X , with the licence number: 16402 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10179 . This is a "BLUE CROSS & BLUE SHIELD" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".




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