Provider Demographics
NPI:1477790194
Name:RICHARD S KLEINMAN MD LLC
Entity Type:Organization
Organization Name:RICHARD S KLEINMAN MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:KLEINMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-765-3200
Mailing Address - Street 1:721 SE 17TH ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33316-2983
Mailing Address - Country:US
Mailing Address - Phone:954-765-3200
Mailing Address - Fax:786-975-2643
Practice Address - Street 1:721 SE 17TH ST
Practice Address - Street 2:SUITE 104
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33316-2983
Practice Address - Country:US
Practice Address - Phone:954-765-3200
Practice Address - Fax:786-975-2643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8746Medicare PIN