MEDICARE: JOHN N KLIM 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	207R00000X	Internal Medicine Physician	MD00028372	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1962494831
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN N KLIM MD

Provider Business Mailing Address
First Line	:	PO BOX 3649
Second Line	:
City	:	SPOKANE
State	:	WA
Zip	:	99220-3649
Country	:	US
Telephone Number	:	509-838-2531
Fax Number	:

Provider Business Practice Location Address
First Line	:	143 GARDEN HOMES DRIVE
Second Line	:	NORTHEASTER WASHINGTON MEDICAL GROUP
City	:	COLVILLE
State	:	WA
Zip	:	99114-0000
Country	:	US
Telephone Number	:	509-684-3701
Fax Number	:

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

Provider Enumeration Date	:	08/17/2005
Last Update Date	:	08/12/2013

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