Healthcare Provider Details

I. General information

NPI: 1518699867
Provider Name (Legal Business Name): MADELINE KLAYSMAT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2022
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 W 66TH ST
RICHFIELD MN
55423-2304
US

IV. Provider business mailing address

2925 CHICAGO AVE
MINNEAPOLIS MN
55407-1321
US

V. Phone/Fax

Practice location:
  • Phone: 612-798-8800
  • Fax: 612-798-8816
Mailing address:
  • Phone: 612-798-8800
  • Fax: 612-798-8816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number14860
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: