MEDICARE: DR. HERBERT KLOSS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	MD00017372	WA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00113699	OTHER	WA	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0139716	OTHER	WA	DEPT OF LABOR & INDUSTRIE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	9638KL	OTHER	WA	REGENCE BLUE SHIELD

General Provider Information

NPI Number	:	1407846504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HERBERT KLOSS MD

Provider Business Mailing Address
First Line	:	PO BOX 5908
Second Line	:
City	:	BELLEVUE
State	:	WA
Zip	:	98006-0408
Country	:	US
Telephone Number	:	206-244-1212
Fax Number	:	206-244-1223

Provider Business Practice Location Address
First Line	:	5057 84TH AVE SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-4617
Country	:	US
Telephone Number	:	206-244-1212
Fax Number	:	206-244-1223

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	07/08/2007

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Directions to “ DR. HERBERT KLOSS MD” Practice Location

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