Healthcare Provider Details

I. General information

NPI: 1710033345
Provider Name (Legal Business Name): JEFF KLEIN DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2007
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 DAVIDSON ST NW
ELKADER IA
52043-9015
US

IV. Provider business mailing address

PO BOX 66
WORTHINGTON IA
52078-0066
US

V. Phone/Fax

Practice location:
  • Phone: 866-228-1060
  • Fax: 866-228-1060
Mailing address:
  • Phone: 866-228-1060
  • Fax: 866-228-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number00540
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number00540
License Number StateIA

VIII. Authorized Official

Name: JEFF A KLEIN
Title or Position: OWNER
Credential: D.P.M.
Phone: 866-228-1060