Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | MK001213 | MI |
NPI | 1255393377 |
---|---|
Provider Name | Mark Jeffery Klein |
First Address | Ann Arbor, MI 48105-9484 |
Second Address | Ypsilanti, MI 48197 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2006 |
Last Update Date | 01/10/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T34166 | (02) | MI |