Provider Demographics
NPI:1912194622
Name:DR. MARCIA E. KLING, MD, PC
Entity Type:Organization
Organization Name:DR. MARCIA E. KLING, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:KLING
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-254-2534
Mailing Address - Street 1:47733 VAN DYKE AVE
Mailing Address - Street 2:
Mailing Address - City:SHELBY TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48317-3372
Mailing Address - Country:US
Mailing Address - Phone:586-254-2534
Mailing Address - Fax:586-254-3889
Practice Address - Street 1:47733 VAN DYKE AVE
Practice Address - Street 2:
Practice Address - City:SHELBY TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48317-3372
Practice Address - Country:US
Practice Address - Phone:586-254-2534
Practice Address - Fax:586-254-3889
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2008-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMK4301060329207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4439533Medicaid
MI4439533Medicaid
MION51950Medicare UPIN