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General NPI Number Information
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NPI Number | 1992241392
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Entity Type | Organization
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Legal Business Name | THE KLEIN SURGERY CENTER, LLC
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 02/01/2017
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Provider Practice Location Address
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Address Line | 2320 DEAN ST SUITE 104
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City | SAINT CHARLES
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State | IL
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Zip | 60175-1068
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Country | US
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Telephone | 847-732-9293
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Fax |
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Provider Business Mailing Address
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Address Line | 2320 DEAN ST SUITE 104
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City | SAINT CHARLES
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State | IL
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Zip | 60175-1068
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Country | US
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Telephone | 847-732-9293
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Fax |
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Authorized Official
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Title or Position | GENERAL SURGEON
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Name | DR. MICHAELA SIMCHA KLEIN
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Credential | DO
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Telephone | 813-404-5572
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 036142139
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License Number State | IL
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