Healthcare Provider Details

I. General information

NPI: 1386620912
Provider Name (Legal Business Name): MICHAEL CRAIG KLEINMANN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 12/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124A SOUTH UNIVERSITY BLVD
MOBILE AL
36608
US

IV. Provider business mailing address

P.O. BOX 850849
MOBILE AL
36685-0849
US

V. Phone/Fax

Practice location:
  • Phone: 251-343-5004
  • Fax: 251-343-5136
Mailing address:
  • Phone: 251-343-5004
  • Fax: 251-343-5136

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberDO584
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberDO-584
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: