Healthcare Provider Details

I. General information

NPI: 1740292069
Provider Name (Legal Business Name): RICHARD DAVID KLEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 E ROLLINS ST STE 5300
ORLANDO FL
32804-5519
US

IV. Provider business mailing address

265 E ROLLINS ST STE 5300
ORLANDO FL
32804-5519
US

V. Phone/Fax

Practice location:
  • Phone: 74-821-3555
  • Fax: 407-821-3556
Mailing address:
  • Phone: 74-821-3555
  • Fax: 407-821-3556

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0122X
TaxonomyPlastic and Reconstructive Surgery Physician
License NumberME93201
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME93201
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: