Provider Demographics
NPI:1093568529
Name:KLEIN, JACOB ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:JACOB
Middle Name:ROBERT
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 1:11885 E 12 MILE RD STE 200B
Mailing Address - Street 2:
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3469
Mailing Address - Country:US
Mailing Address - Phone:586-582-6630
Mailing Address - Fax:586-582-6631
Practice Address - Street 1:11885 E 12 MILE RD STE 200B
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3469
Practice Address - Country:US
Practice Address - Phone:586-582-6630
Practice Address - Fax:586-582-6631
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program