Healthcare Provider Details

I. General information

NPI: 1164559829
Provider Name (Legal Business Name): LAURA KLATT HOUSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LAURA ANN KLATT MD

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4420 LAKE BOONE TRL
RALEIGH NC
27607-7505
US

IV. Provider business mailing address

CB# 7595 US 15-501 AND MANNING DR. UNC FAMILY MEDICINE CENTER
CHAPEL HILL NC
27599-7595
US

V. Phone/Fax

Practice location:
  • Phone: 919-364-3312
  • Fax:
Mailing address:
  • Phone: 919-966-0210
  • Fax: 919-966-6126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number2008-01194
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2008-01194
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: