Provider Demographics
NPI:1871664003
Name:KLEIN, STEFAN FRED (MD)
Entity type:Individual
Prefix:DR
First Name:STEFAN
Middle Name:FRED
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:PO BOX 2139
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95001-2139
Mailing Address - Country:US
Mailing Address - Phone:831-462-4801
Mailing Address - Fax:831-462-4756
Practice Address - Street 1:3143 PAUL SWEET RD
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95065-1521
Practice Address - Country:US
Practice Address - Phone:831-462-4801
Practice Address - Fax:831-462-4756
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG75514207XS0106X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G755140Medicaid
G14388Medicare UPIN
00G755140Medicare PIN