Healthcare Provider Details

I. General information

NPI: 1285680934
Provider Name (Legal Business Name): MICHAEL K KLEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 06/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 S 7TH AVE
BARSTOW CA
92311-3043
US

IV. Provider business mailing address

PO BOX 1547
SEDALIA MO
65302-1547
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-1761
  • Fax:
Mailing address:
  • Phone: 660-826-5960
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberC37496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: