Healthcare Provider Details

I. General information

NPI: 1669444923
Provider Name (Legal Business Name): BRUCE KLEINMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2160 S 1ST AVE LOYOLA UNIVERSITY MEDICAL CENTER 101-1740
MAYWOOD IL
60153
US

IV. Provider business mailing address

2160 S 1ST AVE LOYOLA UNIVERSITY MEDICAL CENTER 101-1740
MAYWOOD IL
60153
US

V. Phone/Fax

Practice location:
  • Phone: 708-216-9000
  • Fax: 708-216-9033
Mailing address:
  • Phone: 708-216-9000
  • Fax: 708-216-9033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number36050465
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: