Provider Demographics
NPI:1790902609
Name:JEFFREY B KLEIN DPM PC
Entity Type:Organization
Organization Name:JEFFREY B KLEIN DPM PC
Other - Org Name:ADVANCED PODIATRY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:B
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-681-6180
Mailing Address - Street 1:3711 ELIZABETH LAKE RD
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48328-3015
Mailing Address - Country:US
Mailing Address - Phone:248-681-6180
Mailing Address - Fax:248-681-6429
Practice Address - Street 1:3711 ELIZABETH LAKE RD
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:MI
Practice Address - Zip Code:48328-3015
Practice Address - Country:US
Practice Address - Phone:248-681-6180
Practice Address - Fax:248-681-6429
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-20
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0838040001Medicare NSC
0P51480Medicare PIN