Basic Information
Provider Information | |||||||||
NPI: | 1912262080 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KLEINMAN | ||||||||
FirstName: | JONATHAN | ||||||||
MiddleName: | THOMAS | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | KLEINMAN | ||||||||
OtherFirstName: | JONATHAN | ||||||||
OtherMiddleName: | THOMAS | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 2 | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 17326 | ||||||||
Address2: |   | ||||||||
City: | DENVER | ||||||||
State: | CO | ||||||||
PostalCode: | 802170326 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3033067783 | ||||||||
FaxNumber: | 3033067753 | ||||||||
Practice Location | |||||||||
Address1: | 501 E HAMPDEN AVE | ||||||||
Address2: |   | ||||||||
City: | ENGLEWOOD | ||||||||
State: | CO | ||||||||
PostalCode: | 801132702 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3037886911 | ||||||||
FaxNumber: | 3037885078 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/05/2012 | ||||||||
LastUpdateDate: | 09/19/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084A2900X | A128879 | CA | N |   |   |   |   | 2084N0400X | DR.0060322 | CO | N |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | 390200000X | TL-4376 | CO | N |   | Student, Health Care | Student in an Organized Health Care Education/Training Program |   | 2084P2900X | DR.0060322 | CO | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Pain Medicine |
No ID Information.