Provider Demographics
NPI:1992241392
Name:THE KLEIN SURGERY CENTER, LLC
Entity type:Organization
Organization Name:THE KLEIN SURGERY CENTER, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAELA
Authorized Official - Middle Name:SIMCHA
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-404-5572
Mailing Address - Street 1:2320 DEAN ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-1068
Mailing Address - Country:US
Mailing Address - Phone:847-732-9293
Mailing Address - Fax:
Practice Address - Street 1:2320 DEAN ST
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT CHARLES
Practice Address - State:IL
Practice Address - Zip Code:60175-1068
Practice Address - Country:US
Practice Address - Phone:847-732-9293
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE KLEIN SURGERY CENTER, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-01-10
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036142139208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003578500Medicaid
FL003578500Medicaid