Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901001655 | MI |
Y | 222Z00000X | Podiatrist | 5901001655 | MI |
NPI | 1063584944 |
---|---|
Provider Name | Gary Lloyd Klein |
First Address | Warren, MI 48093-5527 |
Second Address | Warren, MI 48093-5527 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2006 |
Last Update Date | 08/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U44812 | (02) | MI |