Healthcare Provider Details

I. General information

NPI: 1790901353
Provider Name (Legal Business Name): MEGAN KATHLEEN KLAKRING M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 6TH ST S
ST PETERSBURG FL
33701-4816
US

IV. Provider business mailing address

4713 WHISPERING WIND AVE
TAMPA FL
33614-4916
US

V. Phone/Fax

Practice location:
  • Phone: 727-898-7451
  • Fax:
Mailing address:
  • Phone: 727-215-6880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME 97763
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: