Healthcare Provider Details

I. General information

NPI: 1902146681
Provider Name (Legal Business Name): ANDREW DAVID KLEIN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2013
Last Update Date: 09/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13631 COLORADO BLVD
THORNTON CO
80602-7051
US

IV. Provider business mailing address

1925 MOUNTAIN VIEW AVE
LONGMONT CO
80501-3128
US

V. Phone/Fax

Practice location:
  • Phone: 303-252-2960
  • Fax: 720-494-3113
Mailing address:
  • Phone: 303-776-1234
  • Fax: 720-494-3107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1104347
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: