Provider Demographics
NPI:1376540369
Name:KLEINFELDT, NOSSONAL (MD)
Entity Type:Individual
Prefix:
First Name:NOSSONAL
Middle Name:
Last Name:KLEINFELDT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:NATE
Other - Middle Name:
Other - Last Name:KLEINFELDT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:30150 TELEGRAPH RD STE 271
Mailing Address - Street 2:
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4521
Mailing Address - Country:US
Mailing Address - Phone:248-395-5175
Mailing Address - Fax:248-395-5170
Practice Address - Street 1:33400 6 MILE RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-3165
Practice Address - Country:US
Practice Address - Phone:734-421-2020
Practice Address - Fax:734-421-2020
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-05
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301072297207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382155439OtherCOMMERCIAL INSURANCE
MI180H27019OtherBLUE CARE NETWORK HMO
MI104485008Medicaid
MI180H27019OtherBCBS OF MICHIGAN
MIH66573Medicare UPIN
MI104485008Medicaid