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NPI Code Detail

MEDICARE: DR. KENNETH D. KLEIST MD

MEDICARE: DR. KENNETH D. KLEIST 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
1207X00000XOrthopaedic Surgery Physician54913-20WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1450030707OTHERWIMEDICARE PTAN
2711290105OTHERWIMEDICARE PTAN

General Provider Information

NPI Number : 1528047826
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KENNETH D. KLEIST MD
Provider Business Mailing Address
First Line : PO BOX 22487
Second Line :
City : GREEN BAY
State : WI
Zip : 54305-2487
Country : US
Telephone Number : 920-445-7222
Fax Number : 920-445-7289
Provider Business Practice Location Address
First Line : 1970 S RIDGE RD
Second Line :
City : GREEN BAY
State : WI
Zip : 54304-4125
Country : US
Telephone Number : 920-430-4888
Fax Number : 920-430-4889
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2006
Last Update Date : 12/07/2018

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