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General NPI Number Information
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NPI Number | 1679590186
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Entity Type | Individual
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Provider Name | SAMUEL KLEIN MD
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Gender | Male
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 04/17/2025
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Provider Practice Location Address
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Address Line | 4488 FOREST PARK AVE DIV IM, GERIATRIC MED
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City | SAINT LOUIS
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State | MO
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Zip | 63108-2283
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Country | US
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Telephone | 314-286-2069
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Fax | 314-362-8230
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Provider Business Mailing Address
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Address Line | PO BOX 7412011
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City | CHICAGO
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State | IL
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Zip | 60674-2011
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Country | US
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Telephone | 314-286-2069
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Fax | 314-362-8230
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 107482
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License Number State | MO
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