1225132319 NPI number — AMY KLEINKLAUS-LEE DO

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225132319 NPI number — AMY KLEINKLAUS-LEE DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEINKLAUS-LEE
Provider First Name:
AMY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1225132319
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 W LAKE COOK RD
Provider Second Line Business Mailing Address:
STE 120
Provider Business Mailing Address City Name:
BUFFALO GROVE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60089-2089
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-808-8884
Provider Business Mailing Address Fax Number:
847-808-8890

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 W LAKE COOK RD
Provider Second Line Business Practice Location Address:
STE 120
Provider Business Practice Location Address City Name:
BUFFALO GROVE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60089-2089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-808-8884
Provider Business Practice Location Address Fax Number:
847-808-8890
Provider Enumeration Date:
09/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  036122953 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 061483728 . This is a "HMC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1225132319 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 531880002 . This is a "PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 040040160CT01 . This is a "BCCT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061483728 . This is a "NEDH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061483728 . This is a "ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061483728 . This is a "NYGE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1710959721 . This is a "NPI GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: P2647139 . This is a "OHP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061483728 . This is a "CHCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061483728 . This is a "FIRH" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061483728 . This is a "CGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061483728 . This is a "HLCT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061483728 . This is a "MULT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 160002038 . This is a "MCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2V1497 . This is a "HNET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 401600 . This is a "CTCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061483728 . This is a "GRWE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061483728 . This is a "PHCS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 061483728 . This is a "POMC" identifier . This identifiers is of the category "OTHER".




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