1184668865 NPI number — MARI KLAUSNER M.D.

Table of content: MARI KLAUSNER M.D. (NPI 1184668865)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184668865 NPI number — MARI KLAUSNER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLAUSNER
Provider First Name:
MARI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1184668865
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2210 SUTHERLAND AVE
Provider Second Line Business Mailing Address:
STE 110
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-525-4333
Provider Business Mailing Address Fax Number:
865-212-8879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 SUTHERLAND AVE
Provider Second Line Business Practice Location Address:
STE 110
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-525-4333
Provider Business Practice Location Address Fax Number:
865-212-8879
Provider Enumeration Date:
06/15/2006

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: 207RI0200X , with the licence number:  01061510A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0200X , with the licence number: 47050 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200810790 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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