Healthcare Provider Details

I. General information

NPI: 1447450085
Provider Name (Legal Business Name): MICHAEL PAUL KLINGLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 STACY BURK DRIVE
FLORA IL
62839-3241
US

IV. Provider business mailing address

3402 N GLENWOOD RD
NOBLE IL
62868-2423
US

V. Phone/Fax

Practice location:
  • Phone: 618-662-2191
  • Fax:
Mailing address:
  • Phone: 618-723-2435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036120528
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: