Healthcare Provider Details

I. General information

NPI: 1003816539
Provider Name (Legal Business Name): MICHAEL D. KLEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2005
Last Update Date: 05/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 HUGHES DR STE 620
TOLEDO OH
43606-3845
US

IV. Provider business mailing address

2121 HUGHES DR STE 620
TOLEDO OH
43606-3845
US

V. Phone/Fax

Practice location:
  • Phone: 419-291-2126
  • Fax: 419-291-6967
Mailing address:
  • Phone: 419-291-2126
  • Fax: 419-291-6967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number3508977K
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number4301038107
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number4301038107
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: