Provider Demographics
NPI:1730413394
Name:KLEIN MEDICAL PC
Entity type:Organization
Organization Name:KLEIN MEDICAL PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:N
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:517-279-5099
Mailing Address - Street 1:1131 N OSSEO RD
Mailing Address - Street 2:PO BOX 187
Mailing Address - City:HILLSDALE
Mailing Address - State:MI
Mailing Address - Zip Code:49242-9714
Mailing Address - Country:US
Mailing Address - Phone:517-523-3695
Mailing Address - Fax:517-523-3311
Practice Address - Street 1:370 E CHICAGO ST
Practice Address - Street 2:SUITE 700
Practice Address - City:COLDWATER
Practice Address - State:MI
Practice Address - Zip Code:49036-2062
Practice Address - Country:US
Practice Address - Phone:517-279-5099
Practice Address - Fax:517-279-5097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1730413394Medicaid
MI1730413394OtherBCBSM
MI1730413394OtherBCBSM
MIMI2345Medicare PIN