Provider Demographics
NPI:1376624395
Name:KLEIN, DIANE FIORELLI (MD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:FIORELLI
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DIANE
Other - Middle Name:
Other - Last Name:FIORELLI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:440 W. IH 635
Mailing Address - Street 2:SUITE 355
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75063-3707
Mailing Address - Country:US
Mailing Address - Phone:972-556-1915
Mailing Address - Fax:972-556-1877
Practice Address - Street 1:440 W LYNDON B JOHNSON FWY
Practice Address - Street 2:SUITE 355
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75063-3707
Practice Address - Country:US
Practice Address - Phone:972-556-1915
Practice Address - Fax:972-556-1877
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6623174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
4245542OtherAETNA
752294864 002OtherCIGNA
00EZ89OtherBCBS
126322OtherSIERRA HEALTH
159738411840OtherHUMANA
2821945006OtherCIGNA
752294864001OtherTRICARE/HUMANA
TX00EZ89Medicare ID - Type Unspecified
4245542OtherAETNA