Provider Demographics
NPI:1629261508
Name:MARC B KLEIN DPM PA
Entity Type:Organization
Organization Name:MARC B KLEIN DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-447-7571
Mailing Address - Street 1:7050 W. PALMETTO PARK ROAD
Mailing Address - Street 2:#18
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433
Mailing Address - Country:US
Mailing Address - Phone:561-447-7571
Mailing Address - Fax:561-447-7574
Practice Address - Street 1:7050 W PALMETTO PARK RD STE 18
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3462
Practice Address - Country:US
Practice Address - Phone:561-447-7571
Practice Address - Fax:561-447-7574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-23
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO1505213ES0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL480019906OtherRAILROAD MEDICARE ID
FL480019906OtherRAILROAD MEDICARE ID