Healthcare Provider Details

I. General information

NPI: 1033140868
Provider Name (Legal Business Name): STEVE R KLAFETA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

245 CHERRY ST SE SUITE 207
GRAND RAPIDS MI
49503-4607
US

IV. Provider business mailing address

245 STATE ST SE
GRAND RAPIDS MI
49503-4328
US

V. Phone/Fax

Practice location:
  • Phone: 616-752-5137
  • Fax:
Mailing address:
  • Phone:
  • Fax: 616-913-1818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number4301083065
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: