Healthcare Provider Details

I. General information

NPI: 1508847542
Provider Name (Legal Business Name): JON KLEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 S PRESTON ST
LOUISVILLE KY
40202-1715
US

IV. Provider business mailing address

501 E BROADWAY
LOUISVILLE KY
40202-2043
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5757
  • Fax: 502-852-7643
Mailing address:
  • Phone: 502-589-4856
  • Fax: 502-589-5093

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number22344
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: