Provider Demographics
NPI:1386633279
Name:KLEIN, KEVIN LESLIE (DO)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:LESLIE
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13127 VAIL RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33579-7196
Mailing Address - Country:US
Mailing Address - Phone:813-661-6199
Mailing Address - Fax:813-661-6334
Practice Address - Street 1:13127 VAIL RIDGE DR
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33579-7196
Practice Address - Country:US
Practice Address - Phone:813-661-6199
Practice Address - Fax:813-661-6334
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5117207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL371623600Medicaid
FLF48540Medicare UPIN
FL21275Medicare ID - Type UnspecifiedGROUP NUMBER
FL21275AMedicare ID - Type UnspecifiedGROUP OTHER LOC NUMBER