Provider Demographics
NPI:1194712232
Name:KLEINER, JEFF ALAN (MD)
Entity type:Individual
Prefix:
First Name:JEFF
Middle Name:ALAN
Last Name:KLEINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JEFFREY
Other - Middle Name:ALAN
Other - Last Name:KLEINER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3113 SAEMANN AVE
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-1957
Mailing Address - Country:US
Mailing Address - Phone:920-458-3791
Mailing Address - Fax:
Practice Address - Street 1:3003 W GOOD HOPE RD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53209-2042
Practice Address - Country:US
Practice Address - Phone:414-352-3100
Practice Address - Fax:414-247-4598
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2019-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI48160-0202081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI34652000Medicaid
WI01994-0341Medicare PIN
WII32770Medicare UPIN
WI46236-0340Medicare PIN