Provider Demographics
NPI:1881629541
Name:KLEIN, MORDECAI N (MD)
Entity Type:Individual
Prefix:
First Name:MORDECAI
Middle Name:N
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 OLD SHEPARD PL STE 160
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-5297
Mailing Address - Country:US
Mailing Address - Phone:972-612-4730
Mailing Address - Fax:972-398-9229
Practice Address - Street 1:4701 OLD SHEPARD PL STE 160
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5297
Practice Address - Country:US
Practice Address - Phone:972-612-4730
Practice Address - Fax:972-398-9229
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2020-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH4014207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX135399710Medicaid
TX135399709Medicaid
TX135399709Medicaid
TX8G7611Medicare ID - Type Unspecified
TX8G4025Medicare ID - Type Unspecified
TXC17935Medicare UPIN