Individual
MARY R KLEIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
18780 BAGLEY RD STE 104, CLEVELAND, OH 44130-3304
(440) 816-5950
Mailing address
PO BOX 638269, CINCINNATI, OH 45263-6950
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
35071582
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000543171
ANTHEM BC/BS
OH
05
—
2097707
—
OH
01
—
KL0829213
MEDICARE ID/ 25761 LORAIN
OH
01
—
P00472850
RAIL ROAD CARE
OH
01
—
P00705943
RAILROAD CARE
OH
Enumeration date
08/11/2005
Last updated
01/19/2021
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