Healthcare Provider Details

I. General information

NPI: 1700134640
Provider Name (Legal Business Name): BRIAN CHAD KLEIN P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 12/16/2024
Certification Date: 12/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9401 SW HIGHWAY 200 STE 1001
OCALA FL
34481-9613
US

IV. Provider business mailing address

18228 N US HIGHWAY 41
LUTZ FL
33549-4400
US

V. Phone/Fax

Practice location:
  • Phone: 813-321-1786
  • Fax: 813-321-1787
Mailing address:
  • Phone: 813-321-1786
  • Fax: 813-321-1787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9113064
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: