Provider Demographics
NPI:1386688406
Name:KLEIN, JEFFREY T (DPM)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:T
Last Name:KLEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6371 ALDEN DR
Mailing Address - Street 2:
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-2002
Mailing Address - Country:US
Mailing Address - Phone:248-360-8971
Mailing Address - Fax:
Practice Address - Street 1:20176 LIVERNOIS AVE
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48221-1346
Practice Address - Country:US
Practice Address - Phone:313-934-1155
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001154213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2902380Medicaid
MIP55820001Medicare PIN
MIT34135Medicare UPIN
MI2902380Medicaid