Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081P2900X | Pain Medicine | 48160-020 | WI |
NPI | 1194712232 |
---|---|
Provider Name | Jeff Alan Kleiner |
First Address | Sheboygan, WI 53081-1957 |
Second Address | Milwaukee, WI 53209-2042 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/10/2005 |
Last Update Date | 23/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34652000 | (05) | WI |
I32770 | (02) | WI |