Healthcare Provider Details

I. General information

NPI: 1679518633
Provider Name (Legal Business Name): KRISTI L. KLEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 05/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S PARK ST
MADISON WI
53715-1507
US

IV. Provider business mailing address

2720 STONE PARK BLVD
SIOUX CITY IA
51104-3734
US

V. Phone/Fax

Practice location:
  • Phone: 608-417-6236
  • Fax: 608-417-6377
Mailing address:
  • Phone: 712-279-3410
  • Fax: 712-279-1836

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number51946
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number40508
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: