Healthcare Provider Details

I. General information

NPI: 1003664368
Provider Name (Legal Business Name): WILLIAM KLAIBER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 05/10/2024
Certification Date: 05/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2903 S 5TH ST
IRONTON OH
45638-2866
US

IV. Provider business mailing address

2903 S 5TH ST
IRONTON OH
45638-2866
US

V. Phone/Fax

Practice location:
  • Phone: 740-646-6640
  • Fax:
Mailing address:
  • Phone: 740-646-6640
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.188459
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: