Healthcare Provider Details

I. General information

NPI: 1619036878
Provider Name (Legal Business Name): SANDRA ELIZABETH KLEIN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 05/30/2023
Certification Date: 05/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 S. NEW BALLAS ROAD SUITE 510
SAINT LOUIS MO
63141
US

IV. Provider business mailing address

701 S. NEW BALLAS ROAD SUITE 510
SAINT LOUIS MO
63141
US

V. Phone/Fax

Practice location:
  • Phone: 314-251-6710
  • Fax:
Mailing address:
  • Phone: 314-251-6710
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0004X
TaxonomyOrthopaedic Foot and Ankle Surgery Physician
License Number2007010570
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: