Healthcare Provider Details

I. General information

NPI: 1184610776
Provider Name (Legal Business Name): DEBRA JEAN KLEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1297 BURNS WAY
KALISPELL MT
59901-3166
US

IV. Provider business mailing address

1085 K M RANCH RD
WHITEFISH MT
59937-8382
US

V. Phone/Fax

Practice location:
  • Phone: 406-752-0303
  • Fax: 406-752-0314
Mailing address:
  • Phone: 406-755-4934
  • Fax: 406-755-4934

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number10760
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: