Provider Demographics
NPI:1164520771
Name:KLEIN, TIMOTHY R (MD)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:R
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 1:330 SHIPWATCH PT
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:TN
Mailing Address - Zip Code:38372-5599
Mailing Address - Country:US
Mailing Address - Phone:731-607-2082
Mailing Address - Fax:721-925-0278
Practice Address - Street 1:925 WAYNE RD
Practice Address - Street 2:HARDIN MEDICAL CENTER
Practice Address - City:SAVANNAH
Practice Address - State:TN
Practice Address - Zip Code:38372
Practice Address - Country:US
Practice Address - Phone:731-607-2082
Practice Address - Fax:731-925-0278
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000018016208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3027560Medicaid
A99145Medicare UPIN
TN3027560Medicaid