Healthcare Provider Details

I. General information

NPI: 1407846504
Provider Name (Legal Business Name): HERBERT KLOSS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5057 84TH AVE SE
MERCER ISLAND WA
98040-4617
US

IV. Provider business mailing address

PO BOX 5908
BELLEVUE WA
98006-0408
US

V. Phone/Fax

Practice location:
  • Phone: 206-244-1212
  • Fax: 206-244-1223
Mailing address:
  • Phone: 206-244-1212
  • Fax: 206-244-1223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD00017372
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: