Healthcare Provider Details

I. General information

NPI: 1093236796
Provider Name (Legal Business Name): KEVIN JUDE MATTHEW A CLIMACO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2017
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CENTER DR. HITZELBERGER STRASSE
LANDSTUHL GERMANY
66849
DE

IV. Provider business mailing address

CMR 402 BOX 2117
APO AE
09180-0022
US

V. Phone/Fax

Practice location:
  • Phone: 646-387-9966
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number31826
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: