Provider Demographics
NPI:1306028634
Name:JACKIE KLEIN LEFFERTS MD PA
Entity Type:Organization
Organization Name:JACKIE KLEIN LEFFERTS MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN LEFFERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-294-1024
Mailing Address - Street 1:3428 N ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-4224
Mailing Address - Country:US
Mailing Address - Phone:305-294-1024
Mailing Address - Fax:305-296-2444
Practice Address - Street 1:3428 N ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-4224
Practice Address - Country:US
Practice Address - Phone:305-294-1024
Practice Address - Fax:305-296-2444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME52886174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL12339Medicare PIN
FLE87096Medicare UPIN