Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 008915 | MI |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 008915 | MI |
NPI | 1184799199 |
---|---|
Provider Name | Dr. Jay Albert Klein |
First Address | Muskegon, MI 49443-1848 |
Second Address | Muskegon, MI 49444-1885 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/11/2006 |
Last Update Date | 20/12/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1651016 | (05) | MI |
E26095 | (02) |