Provider Demographics
NPI:1003890054
Name:KLEINPELL, GORDON J (DPM)
Entity Type:Individual
Prefix:
First Name:GORDON
Middle Name:J
Last Name:KLEINPELL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8851 BOARDROOM CIR
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4888
Mailing Address - Country:US
Mailing Address - Phone:239-481-7000
Mailing Address - Fax:239-481-8150
Practice Address - Street 1:2814 LEE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1567
Practice Address - Country:US
Practice Address - Phone:239-481-7000
Practice Address - Fax:239-481-8150
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2052213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1274280001OtherMEDICARE DME
FL4800015521OtherRAILROAD MEDICARE
FL65141ZMedicare PIN
U08595Medicare UPIN
FL65141YMedicare PIN
FL1274280001OtherMEDICARE DME