Healthcare Provider Details

I. General information

NPI: 1679185227
Provider Name (Legal Business Name): RICHARD S KLIMECKI DPM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2020
Last Update Date: 08/19/2020
Certification Date: 08/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30205 SCHOENHERR RD STE A
WARREN MI
48088-6800
US

IV. Provider business mailing address

30205 SCHOENHERR RD STE A
WARREN MI
48088-6800
US

V. Phone/Fax

Practice location:
  • Phone: 586-751-1288
  • Fax: 586-751-0678
Mailing address:
  • Phone: 586-751-1288
  • Fax: 586-751-0678

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: RICHARD KLIMECKI
Title or Position: OWNER/PHYSICIAN
Credential: DPM
Phone: 586-751-1288