Provider Demographics
NPI:1033118187
Name:KLEIN, IAN CHARLES (DPM)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:CHARLES
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7331 DR MARTIN LUTHER KING JR ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33702-5201
Mailing Address - Country:US
Mailing Address - Phone:727-527-1249
Mailing Address - Fax:727-521-1240
Practice Address - Street 1:7331 DR MARTIN LUTHER KING JR ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33702-5201
Practice Address - Country:US
Practice Address - Phone:727-527-1249
Practice Address - Fax:727-521-1240
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO-1411213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL057899100Medicaid
FL65125Medicare PIN
FLT50965Medicare UPIN
FL057899100Medicaid