Healthcare Provider Details

I. General information

NPI: 1497849012
Provider Name (Legal Business Name): MICHAEL JOHN KLEVAY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 11/09/2020
Certification Date: 11/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1959 SLOAN PL SUITE 200
SAINT PAUL MN
55117-2086
US

IV. Provider business mailing address

2854 HIGHWAY 55 STE 130
EAGAN MN
55121-1447
US

V. Phone/Fax

Practice location:
  • Phone: 651-772-6235
  • Fax: 651-772-6261
Mailing address:
  • Phone: 651-842-3349
  • Fax: 651-842-3391

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number36203
License Number StateIA
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number36203
License Number StateIA
# 3
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number51734
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: