Theodore W Kleiman, MD
Individual provider Active NPI Pediatrics Physician · Fargo, ND
NPI 1083640643 · NPPES record last updated Oct 12, 2011
Key facts
- NPI
- 1083640643
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- 7224 (ND)
- Practice address
- 1702 University Dr S
Fargo, ND 58103-4940 - Phone
- (701) 364-3300
- Fax
- (701) 364-8906
- NPI assigned
- Jun 24, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 46225 | MN | MD | Pediatrics Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 7224 | ND | Yes |
| Pediatrics Physician | 208000000X | 46225 | MN |
Addresses
Primary practice location
1702 University Dr S
Fargo, ND 58103-4940
Mailing address
PO Box 6001
Fargo, ND 58108-6001
Phone (701) 364-3300
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 142360 | Other | ND | UCARE # |
| 21042 | Other | ND | SIOUX VALLEY # |
| 57A01KL | Other | ND | MNBS # |
| 904860 | Other | ND | AMERICA'S PPO/ARAZ # |
| ND100006 | Other | ND | LHS # |
| 1202601 | Other | MN | MEDICA # |
| 594523200 | Medicaid | ND | |
| 9L651KL | Other | ND | MNBS # |
| DA9011015646 | Other | ND | PREFERRED ONE # |
| HP19551 | Other | ND | HEALTHPARTNERS # |
| 13167 | Other | ND | NDBS # |
| 18434 | Medicaid | ND | |
| 68G90KL | Other | MN | MNBS # |
| 1202767 | Other | ND | MEDICA # |
Other providers in Fargo, ND
- Stephanie Klabunde
- Matthew B Klaman
- William N Klava
- Kimberly Jo Klayson
- Meagan Jeanann Klefstad
- Madison Mae Klein Mensah
- Jerilyn Ann Klein Wangen
- Brynn H Klein
- Peyton Emma Klein
- Deana Kleindl
All providers in Fargo, ND · Pediatrics Physician in North Dakota
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 12, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.