Provider Demographics
NPI:1336199793
Name:KLEIN, KEVIN M (MD)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:M
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:PO BOX 19305
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28219-9305
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:202 E GROVER ST
Practice Address - Street 2:STE 1
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3977
Practice Address - Country:US
Practice Address - Phone:980-487-2360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC94008792084S0012X, 2084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC4966KOtherBLUE CROSS BLUE SHIELD NC
NC894966KMedicaid
NC1336199793Medicaid
NC1336199793Medicaid
NCNC1458AMedicare PIN
NCB54184Medicare UPIN
NC2198728BMedicare PIN
NCNC1458BMedicare PIN