Healthcare Provider Details

I. General information

NPI: 1669440236
Provider Name (Legal Business Name): MARK A KLIEWER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2348 COMMONWEALTH AVE
MADISON WI
53711-1909
US

IV. Provider business mailing address

2348 COMMONWEALTH AVE
MADISON WI
53711-1909
US

V. Phone/Fax

Practice location:
  • Phone: 87-099-2946
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number44018
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number44018
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: