Healthcare Provider Details

I. General information

NPI: 1467418285
Provider Name (Legal Business Name): JAY C KLEMME MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2006
Last Update Date: 05/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11100 EUCLID AVENUE
CLEVELAND OH
44106
US

IV. Provider business mailing address

1874 CLEVELAND RD
WOOSTER OH
44691-2263
US

V. Phone/Fax

Practice location:
  • Phone: 216-844-3800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number35052120
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: