Healthcare Provider Details

I. General information

NPI: 1770679987
Provider Name (Legal Business Name): ROBERT J KLEIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1652 42ND ST NE SUITE A
CEDAR RAPIDS IA
52402-3075
US

IV. Provider business mailing address

1652 42ND ST NE SUITE A
CEDAR RAPIDS IA
52402-3075
US

V. Phone/Fax

Practice location:
  • Phone: 319-395-0223
  • Fax: 319-395-7832
Mailing address:
  • Phone: 319-395-0223
  • Fax: 319-395-7832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number02045
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code204D00000X
TaxonomyNeuromusculoskeletal Medicine & OMM Physician
License Number16402
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier10179
Identifier TypeOTHER
Identifier StateIA
Identifier IssuerBLUE CROSS & BLUE SHIELD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: