Provider Demographics
NPI:1346206844
Name:KLEINBERG, MARC JOSHUA (MD)
Entity Type:Individual
Prefix:
First Name:MARC
Middle Name:JOSHUA
Last Name:KLEINBERG
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 1:30 N MICHIGAN AVE
Mailing Address - Street 2:SUITE 607
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60602-3402
Mailing Address - Country:US
Mailing Address - Phone:312-726-3917
Mailing Address - Fax:312-726-0474
Practice Address - Street 1:30 N MICHIGAN AVE
Practice Address - Street 2:SUITE 607
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60602-3402
Practice Address - Country:US
Practice Address - Phone:312-726-3917
Practice Address - Fax:312-726-0474
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-108706207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036108706Medicaid
IL206280Medicare ID - Type Unspecified