MEDICARE: MR. PAUL EDWARD KLEIN

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	163W00000X	Registered Nurse	RN188709	AZ
2	363L00000X	Nurse Practitioner	R1337222	MN
3	363LF0000X	Family Nurse Practitioner	AP7448	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639172901
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL EDWARD KLEIN

Provider Business Mailing Address
First Line	:	3832 BEAR DR
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86406-4375
Country	:	US
Telephone Number	:	218-790-3962
Fax Number	:

Provider Business Practice Location Address
First Line	:	1799 KIOWA AVE STE 104
Second Line	:
City	:	LAKE HAVASU CITY
State	:	AZ
Zip	:	86403
Country	:	US
Telephone Number	:	928-505-1030
Fax Number	:	928-453-0461

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

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/29/2018

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Directions to “ MR. PAUL EDWARD KLEIN ” Practice Location

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