Provider Demographics
NPI:1942284740
Name:KLEIN MD HUG MD SABIN MD MADDENS MD & KHOGALI-JAKARY DO PC
Entity Type:Organization
Organization Name:KLEIN MD HUG MD SABIN MD MADDENS MD & KHOGALI-JAKARY DO PC
Other - Org Name:NORTON KLEIN HUG SABIN MADDENS MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:EVANS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-649-8058
Mailing Address - Street 1:3290 W BIG BEAVER RD
Mailing Address - Street 2:STE 420
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-2903
Mailing Address - Country:US
Mailing Address - Phone:248-649-9700
Mailing Address - Fax:248-649-9745
Practice Address - Street 1:3290 W BIG BEAVER RD
Practice Address - Street 2:STE 420
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-2903
Practice Address - Country:US
Practice Address - Phone:248-649-9700
Practice Address - Fax:248-649-9745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-05
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M15930Medicare ID - Type Unspecified