Healthcare Provider Details

I. General information

NPI: 1508860230
Provider Name (Legal Business Name): DONALD KLASING MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2005
Last Update Date: 03/07/2023
Certification Date: 03/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4040 MEMORIAL PKWY SW
HUNTSVILLE AL
35802-4364
US

IV. Provider business mailing address

4040 MEMORIAL PKWY SW STE H
HUNTSVILLE AL
35802-4364
US

V. Phone/Fax

Practice location:
  • Phone: 256-864-3356
  • Fax:
Mailing address:
  • Phone: 256-864-3356
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21172
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number200600548
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number21172
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: