Healthcare Provider Details

I. General information

NPI: 1740078385
Provider Name (Legal Business Name): IAN KLIDA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/25/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 HANCOCK ST
SAGINAW MI
48602-4224
US

IV. Provider business mailing address

500 HANCOCK ST
SAGINAW MI
48602-4224
US

V. Phone/Fax

Practice location:
  • Phone: 989-797-3527
  • Fax: 989-799-0206
Mailing address:
  • Phone: 989-797-3527
  • Fax: 989-799-0206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: