Provider Demographics
NPI:1710033345
Name:JEFF KLEIN DPM PC
Entity Type:Organization
Organization Name:JEFF KLEIN DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:866-228-1060
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52078-0066
Mailing Address - Country:US
Mailing Address - Phone:866-228-1060
Mailing Address - Fax:866-228-1060
Practice Address - Street 1:901 DAVIDSON ST NW
Practice Address - Street 2:
Practice Address - City:ELKADER
Practice Address - State:IA
Practice Address - Zip Code:52043-9015
Practice Address - Country:US
Practice Address - Phone:866-228-1060
Practice Address - Fax:866-228-1060
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00540213E00000X, 213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA8085449Medicaid
IA3085449Medicaid
IA4085449Medicaid
IA6085449Medicaid
IA1747667Medicaid
IA2747667Medicaid
IA5085449Medicaid
IA7085449Medicaid
IA0747667Medicaid
IA0747667Medicaid