Healthcare Provider Details

I. General information

NPI: 1124069992
Provider Name (Legal Business Name): ESTEBAN MARTIN KLOOSTERMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-3725
US

IV. Provider business mailing address

1800 E COMMERCIAL BLVD
FORT LAUDERDALE FL
33308-3725
US

V. Phone/Fax

Practice location:
  • Phone: 954-491-2444
  • Fax: 954-491-8818
Mailing address:
  • Phone: 954-491-2444
  • Fax: 954-491-8818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License NumberME69589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: