MEDICARE: GARY LLOYD KLEIN DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	5901001655	MI

General Provider Information

NPI Number	:	1063584944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY LLOYD KLEIN DPM

Provider Business Mailing Address
First Line	:	31201 CHICAGO RD S
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-5527
Country	:	US
Telephone Number	:	586-979-8811
Fax Number	:	586-979-4794

Provider Business Practice Location Address
First Line	:	31201 CHICAGO RD S
Second Line	:
City	:	WARREN
State	:	MI
Zip	:	48093-5527
Country	:	US
Telephone Number	:	586-979-8811
Fax Number	:	586-979-4794

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	02/08/2008

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