Healthcare Provider Details

I. General information

NPI: 1437141645
Provider Name (Legal Business Name): LONNIE T KLEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2005
Last Update Date: 04/08/2021
Certification Date: 04/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 MEASE DRIVE SUITE 300
SAFETY HARBOR FL
34695
US

IV. Provider business mailing address

12109 COUNTY ROAD 103
OXFORD FL
34484-2951
US

V. Phone/Fax

Practice location:
  • Phone: 727-785-6011
  • Fax: 727-787-6951
Mailing address:
  • Phone: 352-205-8981
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME0075298
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: