Basic Information
| Provider Information | |||||||||
| NPI: | 1912940446 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEIN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6 FOUNTAIN PLAZA | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14202 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166918838 | ||||||||
| FaxNumber: | 7165641134 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 HIGH ST | ||||||||
| Address2: | |||||||||
| City: | BUFFALO | ||||||||
| State: | NY | ||||||||
| PostalCode: | 14203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7166918838 | ||||||||
| FaxNumber: | 7165641134 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2006 | ||||||||
| LastUpdateDate: | 08/21/2014 | ||||||||
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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 | 207P00000X | 1718263 | NY | N | Allopathic & Osteopathic Physicians | Emergency Medicine | 207P00000X | 171826 | NY | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 01174267 | 05 | NY | MEDICAID | 3910175 | 01 | NY | INDEPENDENT HEALTH | OTHER | 930034353 | 01 | NY | RAILROAD MEDICARE | OTHER | 2012829 | 01 | NY | FIDELIS | OTHER | 00026746501 | 01 | NY | UNIVERA | OTHER | 000524709003 | 01 | NY | BLUE CROSS BLUE SHIELD | OTHER |