Provider Demographics
NPI:1770674657
Name:DPMKLEINNRIA LLC
Entity Type:Organization
Organization Name:DPMKLEINNRIA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:563-451-5230
Mailing Address - Street 1:311 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:IA
Mailing Address - Zip Code:52078-9636
Mailing Address - Country:US
Mailing Address - Phone:563-451-5230
Mailing Address - Fax:
Practice Address - Street 1:311 1ST AVE E
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:IA
Practice Address - Zip Code:52078-9636
Practice Address - Country:US
Practice Address - Phone:563-451-5230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-27
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA00540213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI19082Medicare PIN
IAU27487Medicare UPIN