MEDICARE: PAUL DAVID CLEIN MD

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	2084P0804X	Child & Adolescent Psychiatry Physician	MD26419	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	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	3013155	OTHER	BLUE CROSS

General Provider Information

NPI Number	:	1760485866
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL DAVID CLEIN MD

Provider Business Mailing Address
First Line	:	PO BOX 38658
Second Line	:
City	:	GERMANTOWN
State	:	TN
Zip	:	38183-0658
Country	:	US
Telephone Number	:	901-752-0941
Fax Number	:	901-752-0942

Provider Business Practice Location Address
First Line	:	2911 BRUNSWICK RD
Second Line	:	LAKESIDE HOSPITAL
City	:	MEMPHIS
State	:	TN
Zip	:	38133
Country	:	US
Telephone Number	:	901-377-4700
Fax Number	:

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/14/2019

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