Basic Information
| Provider Information | |||||||||
| NPI: | 1336345214 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEMAN | ||||||||
| FirstName: | BRADEY | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | M.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 781076 | ||||||||
| Address2: | |||||||||
| City: | DETROIT | ||||||||
| State: | MI | ||||||||
| PostalCode: | 482781076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175284800 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1703 W STONES CROSSING RD STE 330 | ||||||||
| Address2: | |||||||||
| City: | GREENWOOD | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461438558 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178876060 | ||||||||
| FaxNumber: | 3178595944 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2007 | ||||||||
| LastUpdateDate: | 11/04/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/04/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 22735 | WV | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 01065561A | IN | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.