Basic Information
| Provider Information | |||||||||
| NPI: | 1316917545 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 23133 ORCHARD LAKE RD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483363268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485799220 | ||||||||
| FaxNumber: | 2484267350 | ||||||||
| Practice Location | |||||||||
| Address1: | 23133 ORCHARD LAKE RD STE 200 | ||||||||
| Address2: | |||||||||
| City: | FARMINGTON HILLS | ||||||||
| State: | MI | ||||||||
| PostalCode: | 483363268 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485799220 | ||||||||
| FaxNumber: | 2484719978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/23/2006 | ||||||||
| LastUpdateDate: | 10/01/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 5101008192 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 3040663-11 | 05 | MI | MEDICAID |