MEDICARE: MINX MED

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	208D00000X	General Practice Physician	C75234	CA

General Provider Information

NPI Number	:	1902134588
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MINX MED

Provider Business Mailing Address
First Line	:	10523 BURBANK BLVD
Second Line	:	213
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91601-2233
Country	:	US
Telephone Number	:	818-509-9143
Fax Number	:	818-509-9367

Provider Business Practice Location Address
First Line	:	10523 BURBANK BLVD
Second Line	:	213
City	:	N HOLLYWOOD
State	:	CA
Zip	:	91601-2233
Country	:	US
Telephone Number	:	818-509-9143
Fax Number	:	818-509-9367

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	DR. MICHAEL V KLEIN
Credential	:	M D
Telephone Number	:	818-381-0401

Provider Enumeration Date	:	11/19/2009
Last Update Date	:	11/19/2009

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