Healthcare Provider Details

I. General information

NPI: 1740980630
Provider Name (Legal Business Name): KLINIC MEDICAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2023
Last Update Date: 04/25/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 VILLAGE CENTER CIR # 3-6136
LAS VEGAS NV
89134-6299
US

IV. Provider business mailing address

1201 2ND AVE STE 900
SEATTLE WA
98101-3020
US

V. Phone/Fax

Practice location:
  • Phone: 206-495-0724
  • Fax: 877-823-3570
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ANEEL URSANI
Title or Position: PRESIDENT
Credential: MD
Phone: 206-495-0724