Healthcare Provider Details

I. General information

NPI: 1023082013
Provider Name (Legal Business Name): RICHARD KLEINMANN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2006
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 RANDOLPH RD SUITE 220
CHARLOTTE NC
28207-1100
US

IV. Provider business mailing address

PO BOX 60447
CHARLOTTE NC
28260-0447
US

V. Phone/Fax

Practice location:
  • Phone: 704-316-1125
  • Fax: 704-316-1127
Mailing address:
  • Phone: 704-316-1125
  • Fax: 704-316-1127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number32751
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: