Healthcare Provider Details

I. General information

NPI: 1124120431
Provider Name (Legal Business Name): KEVIN G KLEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

265 GRIFFIN ST E
AMERY WI
54001-1439
US

IV. Provider business mailing address

265 GRIFFIN ST E
AMERY WI
54001-1439
US

V. Phone/Fax

Practice location:
  • Phone: 715-268-8000
  • Fax: 715-268-0311
Mailing address:
  • Phone: 715-268-8000
  • Fax: 715-268-0311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number38035
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number53810
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: