Healthcare Provider Details

I. General information

NPI: 1497275952
Provider Name (Legal Business Name): KLEINE PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2017
Last Update Date: 07/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 E CENTRAL AVENUE SUITE 391
WINTER HAVEN FL
33880
US

IV. Provider business mailing address

375 E CENTRAL AVE SUITE 391
WINTER HAVEN FL
33880
US

V. Phone/Fax

Practice location:
  • Phone: 863-656-1111
  • Fax: 863-656-1113
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME53582
License Number StateFL

VIII. Authorized Official

Name: DR. JOSEF STEPAN KLEINE
Title or Position: OWNER
Credential: MD
Phone: 863-656-1111