Healthcare Provider Details

I. General information

NPI: 1003831538
Provider Name (Legal Business Name): ELLIOT L KLEINMAN DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 N 5TH ST
TERRE HAUTE IN
47804-4010
US

IV. Provider business mailing address

3760 S 4TH ST
TERRE HAUTE IN
47802-5507
US

V. Phone/Fax

Practice location:
  • Phone: 812-232-0564
  • Fax: 812-231-4757
Mailing address:
  • Phone: 812-234-3558
  • Fax: 812-232-0355

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number07000448
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: