Provider Demographics
NPI:1043212566
Name:KLEIN, MARC B (DPM)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:B
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 1:7050 W PALMETTO PARK RD
Mailing Address - Street 2:SUITE #18
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3426
Mailing Address - Country:US
Mailing Address - Phone:561-447-7571
Mailing Address - Fax:561-447-7574
Practice Address - Street 1:7050 W PALMETTO PARK RD
Practice Address - Street 2:SUITE #18
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3426
Practice Address - Country:US
Practice Address - Phone:561-447-7571
Practice Address - Fax:561-447-7574
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO 1505213E00000X, 213EP1101X, 213ES0000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL390121101Medicaid
FL480019906OtherRAILROAD MEDICARE
FL87854XOtherMEDICARE
FL87854Medicare ID - Type Unspecified
FL480019906OtherRAILROAD MEDICARE