Provider Demographics
NPI:1740347111
Name:KLEIN, NICOLE R (MD)
Entity type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:R
Last Name:KLEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 N ILLINOIS ST STE 110
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46290-1172
Mailing Address - Country:US
Mailing Address - Phone:317-819-4516
Mailing Address - Fax:317-819-0044
Practice Address - Street 1:18051 RIVER AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-7093
Practice Address - Country:US
Practice Address - Phone:317-573-4370
Practice Address - Fax:317-819-0044
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2024-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050069A207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN040017759OtherMEDICARE RAILROAD
IN200380850Medicaid
IN040017759OtherMEDICARE RAILROAD
IN200380850Medicaid