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NPI Code Detail

MEDICARE: KLONIE L BEREND M.D.

MEDICARE: KLONIE L BEREND M.D.
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
12085R0202XDiagnostic Radiology PhysicianK9944TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1A018OTHERTXHUMANA MILITARY HEALTHPLA
2MDK9944OTHERTXWORKERS COMPENSATION
3123761OTHERTXSUPERIOR HEALTH PLAN
485371ROTHERTXBLUE CROSS BLUE SHIELD

General Provider Information

NPI Number : 1922176585
Entity Type Code : Individual
Provider Name (Legal Business Name) : KLONIE L BEREND M.D.
Provider Business Mailing Address
First Line : 808 BROOK AVE
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76301-4209
Country : US
Telephone Number : 940-766-0217
Fax Number : 940-766-0730
Provider Business Practice Location Address
First Line : 808 BROOK AVE
Second Line :
City : WICHITA FALLS
State : TX
Zip : 76301-4209
Country : US
Telephone Number : 940-766-0217
Fax Number : 940-766-0730
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2006
Last Update Date : 12/07/2007

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Directions to “ KLONIE L BEREND M.D.” Practice Location

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