Provider Demographics
NPI:1083640643
Name:KLEIMAN, THEODORE W (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:W
Last Name:KLEIMAN
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:PO BOX 6001
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58108-6001
Mailing Address - Country:US
Mailing Address - Phone:701-364-3300
Mailing Address - Fax:701-364-8906
Practice Address - Street 1:1702 UNIVERSITY DR S
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58103-4940
Practice Address - Country:US
Practice Address - Phone:701-364-3300
Practice Address - Fax:701-364-8906
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7224208000000X
MN46225208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND142360OtherUCARE #
ND21042OtherSIOUX VALLEY #
ND57A01KLOtherMNBS #
ND904860OtherAMERICA'S PPO/ARAZ #
NDND100006OtherLHS #
MN1202601OtherMEDICA #
ND594523200Medicaid
ND9L651KLOtherMNBS #
NDDA9011015646OtherPREFERRED ONE #
NDHP19551OtherHEALTHPARTNERS #
ND13167OtherNDBS #
ND18434Medicaid
MN68G90KLOtherMNBS #
ND1202767OtherMEDICA #
ND370013418Medicare ID - Type UnspecifiedRRR MEDICARE #
NDND100006OtherLHS #
ND9L651KLOtherMNBS #
ND1202767OtherMEDICA #
ND57A01KLOtherMNBS #