1841208782 NPI number — IRINA VIKTOROVNA KLIMOVA MD

Table of content: IRINA VIKTOROVNA KLIMOVA MD (NPI 1841208782)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841208782 NPI number — IRINA VIKTOROVNA KLIMOVA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLIMOVA
Provider First Name:
IRINA
Provider Middle Name:
VIKTOROVNA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KVATADZE
Provider Other First Name:
IRINA
Provider Other Middle Name:
VIKTOROVNA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1841208782
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 131158
Provider Second Line Business Mailing Address:
ANN ARBOR INPT PHYSICIANS
Provider Business Mailing Address City Name:
ANN ARBOR
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48113-1158
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
734-737-0970
Provider Business Mailing Address Fax Number:
734-737-0974

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5301 E HURON RIVER DR
Provider Second Line Business Practice Location Address:
ST JOSEPH MERCY HOSPITAL
Provider Business Practice Location Address City Name:
YPSILANTI
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48197
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
734-712-3456
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/04/2006

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: 207R00000X , with the licence number:  4301079903 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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