Provider Demographics
NPI:1912940446
Name:KLEIN, MICHAEL J (DO)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6 FOUNTAIN PLAZA
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202
Mailing Address - Country:US
Mailing Address - Phone:716-691-8838
Mailing Address - Fax:716-564-1134
Practice Address - Street 1:100 HIGH ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:716-691-8838
Practice Address - Fax:716-564-1134
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1718263207P00000X
NY171826207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01174267Medicaid
NY3910175OtherINDEPENDENT HEALTH
NY930034353OtherRAILROAD MEDICARE
NY2012829OtherFIDELIS
NY00026746501OtherUNIVERA
NY000524709003OtherBLUE CROSS BLUE SHIELD
NY2012829OtherFIDELIS
NYE93606Medicare UPIN