Provider Demographics
NPI:1982887550
Name:GORDON J KLEINPELL DPM PA
Entity Type:Organization
Organization Name:GORDON J KLEINPELL DPM PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLEINPELL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:239-481-7000
Mailing Address - Street 1:8851 BOARDROOM CIR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-4888
Mailing Address - Country:US
Mailing Address - Phone:239-481-7000
Mailing Address - Fax:239-481-8150
Practice Address - Street 1:2814 LEE BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33971-1567
Practice Address - Country:US
Practice Address - Phone:239-368-5600
Practice Address - Fax:239-481-8150
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2010-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2052213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU08595Medicare UPIN
FL1274280001Medicare NSC
FL65141Medicare PIN