Provider Demographics
NPI:1588930200
Name:KLEIN, TED DANIEL (MD)
Entity type:Individual
Prefix:
First Name:TED
Middle Name:DANIEL
Last Name:KLEIN
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 1:168 MOBILE INFIRMARY BLVD
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36607-3510
Mailing Address - Country:US
Mailing Address - Phone:251-433-1895
Mailing Address - Fax:
Practice Address - Street 1:168 MOBILE INFIRMARY BLVD
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3510
Practice Address - Country:US
Practice Address - Phone:251-433-1895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-27
Last Update Date:2024-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR7792208800000X
AL35893208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX389796902Medicaid
TX389796901Medicaid