Provider Demographics
NPI:1770679987
Name:KLEIN, ROBERT J (DO)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1652 42ND ST NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52402-3075
Mailing Address - Country:US
Mailing Address - Phone:319-395-0223
Mailing Address - Fax:319-395-7832
Practice Address - Street 1:1652 42ND ST NE
Practice Address - Street 2:SUITE A
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-3075
Practice Address - Country:US
Practice Address - Phone:319-395-0223
Practice Address - Fax:319-395-7832
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA02045204D00000X
OR16402204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA10179OtherBLUE CROSS & BLUE SHIELD
IAE68156Medicare UPIN