Healthcare Provider Details

I. General information

NPI: 1154440048
Provider Name (Legal Business Name): THEA M KLINGBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2007
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 WHEELER PEARK DR.
LAS VEGAS NV
89106
US

IV. Provider business mailing address

1800 W. CHARLESTON BLVD. STE. 508
LAS VEGAS NV
89102
US

V. Phone/Fax

Practice location:
  • Phone: 702-383-2565
  • Fax: 702-646-0298
Mailing address:
  • Phone: 702-383-2688
  • Fax: 702-671-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number908NV
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: