Provider Demographics
NPI:1073516415
Name:KLEIN, MICHAEL ELIHU (MD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ELIHU
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 1:3714 NORRISVILLE ROAD
Mailing Address - Street 2:
Mailing Address - City:JARRETTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21084-1838
Mailing Address - Country:US
Mailing Address - Phone:410-504-9511
Mailing Address - Fax:888-691-8524
Practice Address - Street 1:3714 NORRISVILLE ROAD
Practice Address - Street 2:
Practice Address - City:JARRETTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21084-1838
Practice Address - Country:US
Practice Address - Phone:410-504-9511
Practice Address - Fax:888-691-8524
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17515207RH0000X, 207R00000X
PAMD028674E207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAA85458Medicare UPIN