1477545853 NPI number — DAVID A KLEINER MD

Table of content: DAVID A KLEINER MD (NPI 1477545853)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477545853 NPI number — DAVID A KLEINER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEINER
Provider First Name:
DAVID
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KLEINER
Provider Other First Name:
DAVID
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1477545853
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15650 N BLACK CANYON HWY
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85053-4064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-866-0550
Provider Business Mailing Address Fax Number:
602-993-5788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2030 W WHISPERING WIND DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85085-2853
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-866-0550
Provider Business Practice Location Address Fax Number:
602-993-5788
Provider Enumeration Date:
08/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  25382 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 385262 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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