Provider Demographics
NPI:1922007590
Name:KLEIN, WILLIAM (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
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 1:220 E 4TH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-4102
Mailing Address - Country:US
Mailing Address - Phone:513-964-0830
Mailing Address - Fax:855-412-7814
Practice Address - Street 1:220 E 4TH ST STE 130
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-4102
Practice Address - Country:US
Practice Address - Phone:513-964-0830
Practice Address - Fax:855-412-7814
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35 077821207QS0010X
OH35.077821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2607432Medicaid
OH2607432Medicaid
OH4163423Medicare PIN
OHKL4163424Medicare PIN
OHH38151Medicare UPIN
OHP00915561Medicare PIN