MEDICARE: CHRISTIAN KLAMERT

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	164W00000X	Licensed Practical Nurse	2014022464	MO

General Provider Information

NPI Number	:	1538525647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTIAN KLAMERT

Provider Business Mailing Address
First Line	:	227 MAIN ST
Second Line	:
City	:	FESTUS
State	:	MO
Zip	:	63028-1952
Country	:	US
Telephone Number	:	636-931-2700
Fax Number	:	636-931-5304

Provider Business Practice Location Address
First Line	:	324 EMERSON RD
Second Line	:
City	:	HIGH RIDGE
State	:	MO
Zip	:	63049-2542
Country	:	US
Telephone Number	:	636-677-9977
Fax Number	:	636-677-9179

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

Provider Enumeration Date	:	01/05/2016
Last Update Date	:	01/05/2016

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