Healthcare Provider Details

I. General information

NPI: 1972873842
Provider Name (Legal Business Name): HERBERT KLOSS, M.D. PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
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

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

V. Phone/Fax

Practice location:
  • Phone: 253-375-6937
  • Fax:
Mailing address:
  • Phone: 253-375-6937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP3000X
TaxonomyPediatric Anesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: HERBERT KLOSS
Title or Position: OWNER
Credential: M.D.
Phone: 253-375-6937