Healthcare Provider Details

I. General information

NPI: 1225132319
Provider Name (Legal Business Name): AMY KLEINKLAUS-LEE DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 01/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W LAKE COOK RD STE 120
BUFFALO GROVE IL
60089-2089
US

IV. Provider business mailing address

600 W LAKE COOK RD STE 120
BUFFALO GROVE IL
60089-2089
US

V. Phone/Fax

Practice location:
  • Phone: 847-808-8884
  • Fax: 847-808-8890
Mailing address:
  • Phone: 847-808-8884
  • Fax: 847-808-8890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number036122953
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: