Healthcare Provider Details

I. General information

NPI: 1356874440
Provider Name (Legal Business Name): MICHAEL KLINGLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3770 CAPITAL AVE SW STE A
BATTLE CREEK MI
49015-9411
US

IV. Provider business mailing address

26 SHELDON BLVD APT 611
GRAND RAPIDS MI
49503
US

V. Phone/Fax

Practice location:
  • Phone: 269-441-1771
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number1356874440
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number4301512415
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: