Healthcare Provider Details

I. General information

NPI: 1124501515
Provider Name (Legal Business Name): MATTHEW ALAN KLIMEK NP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 09/11/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

225 SMITH AVE N STE 400
SAINT PAUL MN
55102-2568
US

IV. Provider business mailing address

225 SMITH AVE N STE 400
SAINT PAUL MN
55102-2568
US

V. Phone/Fax

Practice location:
  • Phone: 651-241-2780
  • Fax: 651-241-2785
Mailing address:
  • Phone: 651-241-2780
  • Fax: 651-241-2785

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number6138
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: