MEDICARE: DR. JAY H. KLEIMAN M.D.

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	207RC0000X	Cardiovascular Disease Physician		IL

General Provider Information

NPI Number	:	1275722373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY H. KLEIMAN M.D.

Provider Business Mailing Address
First Line	:	1875 S JAMES CT N
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-4624
Country	:	US
Telephone Number	:	847-295-7380
Fax Number	:	847-295-7518

Provider Business Practice Location Address
First Line	:	1875 S JAMES CT N
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-4624
Country	:	US
Telephone Number	:	847-295-7380
Fax Number	:	847-295-7518

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

Provider Enumeration Date	:	10/15/2007
Last Update Date	:	10/15/2007

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