Healthcare Provider Details

I. General information

NPI: 1518103316
Provider Name (Legal Business Name): MATTHEW LEE KLIMA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2008
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1921 WALDEMERE ST SUITE 504
SARASOTA FL
34239-2943
US

IV. Provider business mailing address

PO BOX 863407
ORLANDO FL
32886-3407
US

V. Phone/Fax

Practice location:
  • Phone: 941-917-8525
  • Fax: 941-917-8526
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberOS11307
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License NumberOS11307
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: