Healthcare Provider Details

I. General information

NPI: 1356544142
Provider Name (Legal Business Name): JONATHAN WILLIAM KLEIN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2007
Last Update Date: 12/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PERKINS SQ
AKRON OH
44308-1063
US

IV. Provider business mailing address

PO BOX 232
RAVENNA OH
44266-0232
US

V. Phone/Fax

Practice location:
  • Phone: 330-543-8823
  • Fax:
Mailing address:
  • Phone: 330-867-1034
  • Fax: 330-296-6535

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number34-008770
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: