Provider Demographics
NPI:1447222559
Name:WINDSOR MEDICAL ASSOCIATES LLC
Entity Type:Organization
Organization Name:WINDSOR MEDICAL ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:IAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KLEINHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-298-8830
Mailing Address - Street 1:74 MACK ST
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-2759
Mailing Address - Country:US
Mailing Address - Phone:860-298-8830
Mailing Address - Fax:860-298-9929
Practice Address - Street 1:74 MACK ST
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-2759
Practice Address - Country:US
Practice Address - Phone:860-298-8830
Practice Address - Fax:860-298-9929
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-02
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC03458Medicare PIN