MEDICARE: HERBERT KLOSS, M.D. PLLC

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	207LP3000X	Pediatric Anesthesiology Physician

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	:	1972873842
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HERBERT KLOSS, M.D. PLLC

Provider Business Mailing Address
First Line	:	5057 84TH AVE SE
Second Line	:
City	:	MERCER ISLAND
State	:	WA
Zip	:	98040-4617
Country	:	US
Telephone Number	:	253-375-6937
Fax Number	:

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	:	253-375-6937
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HERBERT KLOSS
Credential	:	M.D.
Telephone Number	:	253-375-6937

Provider Enumeration Date	:	01/09/2012
Last Update Date	:	01/09/2012

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