Provider Demographics
NPI:1497275952
Name:KLEINE PEDIATRICS
Entity Type:Organization
Organization Name:KLEINE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEF
Authorized Official - Middle Name:STEPAN
Authorized Official - Last Name:KLEINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-656-1111
Mailing Address - Street 1:375 E CENTRAL AVE
Mailing Address - Street 2:SUITE 391
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:375 E CENTRAL AVENUE
Practice Address - Street 2:SUITE 391
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880
Practice Address - Country:US
Practice Address - Phone:863-656-1111
Practice Address - Fax:863-656-1113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-26
Last Update Date:2017-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME53582208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1952412637OtherPEDIATRICS