Healthcare Provider Details

I. General information

NPI: 1619619426
Provider Name (Legal Business Name): ALLISON MARIE KLIMESH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2022
Last Update Date: 06/24/2026
Certification Date: 06/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 W RACINE ST
JEFFERSON WI
53549-1053
US

IV. Provider business mailing address

PO BOX 249
FORT ATKINSON WI
53538-0249
US

V. Phone/Fax

Practice location:
  • Phone: 920-674-6000
  • Fax:
Mailing address:
  • Phone: 920-563-4466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number85973-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: