Healthcare Provider Details

I. General information

NPI: 1184902140
Provider Name (Legal Business Name): MR. KLAUS FRIEDEMANN EYTING
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KLAUS EYTING ATP

II. Dates (important events)

Enumeration Date: 07/25/2011
Last Update Date: 07/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1104 W 34TH ST
AUSTIN TX
78705-1908
US

IV. Provider business mailing address

1104 W 34TH ST
AUSTIN TX
78705-1908
US

V. Phone/Fax

Practice location:
  • Phone: 512-458-4589
  • Fax: 512-454-9521
Mailing address:
  • Phone: 512-458-4589
  • Fax: 512-454-9521

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number74-2556119
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: