1235259888 NPI number — DR. WILLIAM ROLAND KLEMME M.D.

Table of content: DR. WILLIAM ROLAND KLEMME M.D. (NPI 1235259888)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235259888 NPI number — DR. WILLIAM ROLAND KLEMME M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KLEMME
Provider First Name:
WILLIAM
Provider Middle Name:
ROLAND
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1235259888
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:
336 BON AIR SHOPPING CTR
Provider Second Line Business Mailing Address:
#388
Provider Business Mailing Address City Name:
GREENBRAE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94904-3017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
415-461-1650
Provider Business Mailing Address Fax Number:
415-461-1650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
336 BON AIR SHOPPING CTR
Provider Second Line Business Practice Location Address:
#388
Provider Business Practice Location Address City Name:
GREENBRAE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94904-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
415-461-1650
Provider Business Practice Location Address Fax Number:
415-461-1650
Provider Enumeration Date:
03/29/2007

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: 207XS0117X , with the licence number:  G58946 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DE2303 . This is a "RAILROAD MEDICARE PART B" identifier . This identifiers is of the category "OTHER".




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