Healthcare Provider Details

I. General information

NPI: 1962406405
Provider Name (Legal Business Name): COURTNEY BURNS KLEBER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2005
Last Update Date: 06/21/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 W TIPTON ST STE D
SEYMOUR IN
47274-2794
US

IV. Provider business mailing address

1171 W TIPTON ST STE D
SEYMOUR IN
47274-2794
US

V. Phone/Fax

Practice location:
  • Phone: 812-524-8780
  • Fax: 812-524-8746
Mailing address:
  • Phone: 812-524-8780
  • Fax: 812-524-8746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number01049004A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: