Provider Demographics
NPI:1518966589
Name:KLEIN, MARY Y (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:Y
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2022 KELLE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERTON
Mailing Address - State:IN
Mailing Address - Zip Code:46304-8708
Mailing Address - Country:US
Mailing Address - Phone:219-364-3616
Mailing Address - Fax:219-364-3610
Practice Address - Street 1:85 E US HIGHWAY 6 STE 200
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383
Practice Address - Country:US
Practice Address - Phone:219-983-6260
Practice Address - Fax:219-983-6010
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2020-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01034294207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN110119928OtherTRAVELERS MCR PROVDIER #
IN100209090Medicaid
IN000000091408OtherBCBS PROVIDER NUMBER