Healthcare Provider Details

I. General information

NPI: 1659532869
Provider Name (Legal Business Name): DEBORAH G. KLEIMAN-CORNELL MD, MPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH GAIL KLEIMAN MD

II. Dates (important events)

Enumeration Date: 06/19/2008
Last Update Date: 10/14/2024
Certification Date: 10/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 S J ST MS 01 27 DEPT OF EM
TACOMA WA
98405
US

IV. Provider business mailing address

18209 53RD STREET CT E
LAKE TAPPS WA
98391-8955
US

V. Phone/Fax

Practice location:
  • Phone: 253-426-6660
  • Fax:
Mailing address:
  • Phone: 804-249-2719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number036.127237
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD60331128
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: