Provider Demographics
NPI:1194920041
Name:KLEIN, JUSTIN D (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:D
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3901 BEAUBIEN ST
Mailing Address - Street 2:CARLS BUILDING 2ND FLOOR
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2119
Mailing Address - Country:US
Mailing Address - Phone:313-831-3220
Mailing Address - Fax:313-745-0747
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:CARLS BUILDING 2ND FLOOR
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-831-3220
Practice Address - Fax:313-745-0747
Is Sole Proprietor?:No
Enumeration Date:2007-06-20
Last Update Date:2014-11-07
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Provider Licenses
StateLicense IDTaxonomies
MI43010860402086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396817714OtherGROUP NPI