Provider Demographics
NPI:1003816539
Name:KLEIN, MICHAEL D (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:KLEIN
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 1:2121 HUGHES DR
Mailing Address - Street 2:STE 620
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-3845
Mailing Address - Country:US
Mailing Address - Phone:419-291-2126
Mailing Address - Fax:419-291-6967
Practice Address - Street 1:2121 HUGHES DR
Practice Address - Street 2:STE 620
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-3845
Practice Address - Country:US
Practice Address - Phone:419-291-2126
Practice Address - Fax:419-291-6967
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010381072086S0102X, 2086S0120X
OH3508977K208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2086S0102XAllopathic & Osteopathic PhysiciansSurgerySurgical Critical Care
No2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0650960OtherBCMH
MI4115642Medicaid
OH7697OtherHEALTH PLAN OF MI
OH0650960Medicaid
700H262280OtherBLUE CROSS-BLUE CROSS
OH000000521510OtherANTHEM
OH04671OtherPARAMOUNT
147949OtherGLHP
MI4614571Medicaid
MK038107OtherCOMMERCIAL-COMMERCIAL NUMBER
020H277290OtherBLUE CROSS BLUE SHIELD MI
MI1428394Medicaid
MI5210280Medicaid
MI301415310Medicaid
4295600OtherAETNA
MK038107OtherCHAMPUS-CHAMPUS
MI5210280Medicaid
MI4115642Medicaid