Provider Demographics
NPI:1598706590
Name:KLEIN, MICHAEL ALAN (DPM)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALAN
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:534 WINDING ROSE DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-2869
Mailing Address - Country:US
Mailing Address - Phone:301-953-3668
Mailing Address - Fax:301-953-3854
Practice Address - Street 1:14440 CHERRY LANE CT
Practice Address - Street 2:SUITE # 104
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-4946
Practice Address - Country:US
Practice Address - Phone:301-953-3668
Practice Address - Fax:301-953-3854
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD1302213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD001504100Medicaid
DC000Y88L00Medicare ID - Type Unspecified
MD001504100Medicaid