Provider Demographics
NPI:1629073945
Name:KLEIN, IRA A (MD)
Entity type:Individual
Prefix:
First Name:IRA
Middle Name:A
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:IRA
Other - Middle Name:
Other - Last Name:KLEIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10016 SUMMIT CANYON DR.
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89144
Mailing Address - Country:US
Mailing Address - Phone:702-245-6979
Mailing Address - Fax:702-947-4757
Practice Address - Street 1:8874 COMMERCE LOOP DR
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43240-2122
Practice Address - Country:US
Practice Address - Phone:614-271-9142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2024-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16161174400000X, 207L00000X
NJMA 69597174400000X
NY1901351207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1629073945Medicaid
NJ8314608Medicaid
G67839Medicare UPIN