Basic Information
| Provider Information | |||||||||
| NPI: | 1669799797 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEINMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | SCOTT | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | P O BOX 1000 | ||||||||
| Address2: | DEPT 457 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 38148 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9017587888 | ||||||||
| FaxNumber: | 9012666445 | ||||||||
| Practice Location | |||||||||
| Address1: | UT COLLEGE OF MEDICINE | ||||||||
| Address2: | 910 MADISON AVENUE SUITE 1031 | ||||||||
| City: | MEMPHIS | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381630001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9014485364 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/29/2010 | ||||||||
| LastUpdateDate: | 06/25/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/25/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 49710 | TN | N | Allopathic & Osteopathic Physicians | Pediatrics | 207R00000X | 49710 | TN | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.