Provider Demographics
NPI:1487745485
Name:KLEIN, ALAN BARRY (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:BARRY
Last Name:KLEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 ROUGE WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40218-1540
Mailing Address - Country:US
Mailing Address - Phone:502-807-7129
Mailing Address - Fax:866-902-0669
Practice Address - Street 1:3903 VANTAGE PL
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-6801
Practice Address - Country:US
Practice Address - Phone:502-356-4377
Practice Address - Fax:888-959-2460
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24316207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000063086OtherBCBS
KY64243165Medicaid
18DOG82295OtherCLIA
2432467001OtherPASSPORT ADVANTAGE
2432467001OtherPASSPORT ADVANTAGE
D32302Medicare UPIN
KYK164320Medicare PIN
KY9541Medicare PIN