Provider Demographics
NPI:1043330285
Name:KLEIN, MICHAELA SIMCHA (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAELA
Middle Name:SIMCHA
Last Name:KLEIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3810 NORTHDALE BLVD STE 260
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33624-1870
Mailing Address - Country:US
Mailing Address - Phone:813-961-1331
Mailing Address - Fax:813-961-6336
Practice Address - Street 1:1640 N ARLINGTON HEIGHTS RD STE 201
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-3985
Practice Address - Country:US
Practice Address - Phone:800-991-6117
Practice Address - Fax:888-812-8191
Is Sole Proprietor?:No
Enumeration Date:2007-03-30
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142139208600000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL003578500Medicaid
ILP01322156OtherR&R MEDICARE
FLP01322156OtherR&R MEDICARE
FL003578500Medicaid
ILFG248XMedicare PIN
FLP01322156OtherR&R MEDICARE