Provider Demographics
NPI:1265481691
Name:KLEIN, SUSAN (CNM)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:KLEIN
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 BELLE AVE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-4202
Mailing Address - Country:US
Mailing Address - Phone:216-227-2500
Mailing Address - Fax:216-227-2567
Practice Address - Street 1:1450 BELLE AVE
Practice Address - Street 2:SUITE 310
Practice Address - City:LAKEWOOD
Practice Address - State:OH
Practice Address - Zip Code:44107-4202
Practice Address - Country:US
Practice Address - Phone:216-227-2500
Practice Address - Fax:216-227-2567
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2009-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN196852176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0133528Medicaid
OHMN00263Medicare PIN
OH0133528Medicaid
OHNM00264Medicare PIN