Provider Demographics
NPI:1386623007
Name:KLEINBERG, DAVID C (MD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:C
Last Name:KLEINBERG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11126 432D AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57247-6118
Mailing Address - Country:US
Mailing Address - Phone:605-448-2306
Mailing Address - Fax:
Practice Address - Street 1:11126 432D AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:SD
Practice Address - Zip Code:57247-6118
Practice Address - Country:US
Practice Address - Phone:605-448-2306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28010207Q00000X
FLME 75858207Q00000X
SD6047207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND654518Medicaid
SD657926OtherDAKOTACARE
SD657929OtherWELLMARK BC/BS
SD657934Medicaid
SD657929OtherWELLMARK BC/BS
S652524Medicare PIN