Healthcare Provider Details

I. General information

NPI: 1992806194
Provider Name (Legal Business Name): WILLIAM CLAYTON KLECKNER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 04/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7526 E 82ND ST STE 125
INDIANAPOLIS IN
46256-1467
US

IV. Provider business mailing address

8840 COMMERCE PARK PL STE E
INDIANAPOLIS IN
46268-3129
US

V. Phone/Fax

Practice location:
  • Phone: 317-415-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code170100000X
TaxonomyPh.D. Medical Genetics
License Number01030319
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01030319A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: