MEDICARE: AMANDA STIEHL KLEINMAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	036.118724	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1740380203	OTHER	IL	NPI

General Provider Information

NPI Number	:	1740380203
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA STIEHL KLEINMAN MD

Provider Business Mailing Address
First Line	:	2150 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3706
Country	:	US
Telephone Number	:	312-942-9336
Fax Number	:	312-942-3186

Provider Business Practice Location Address
First Line	:	2150 W HARRISON ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60612-3706
Country	:	US
Telephone Number	:	312-942-9336
Fax Number	:	312-942-3186

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/25/2006
Last Update Date	:	06/02/2009

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