Provider Demographics
NPI:1609141365
Name:DONNA H KLEBAN MD FACS PA
Entity Type:Organization
Organization Name:DONNA H KLEBAN MD FACS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:H
Authorized Official - Last Name:KLEBAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-791-3301
Mailing Address - Street 1:1395 S STATE ROAD 7
Mailing Address - Street 2:SUITE 410
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9325
Mailing Address - Country:US
Mailing Address - Phone:561-791-3301
Mailing Address - Fax:561-791-7745
Practice Address - Street 1:1395 S STATE ROAD 7
Practice Address - Street 2:SUITE 410
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9325
Practice Address - Country:US
Practice Address - Phone:561-791-3301
Practice Address - Fax:561-791-7745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-14
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056902208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11776Medicare PIN