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General NPI Number Information
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NPI Number | 1003842915
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Entity Type | Individual
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Provider Name | DAVID A KLOSS M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2006
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Last Update Date | 06/05/2019
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Provider Practice Location Address
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Address Line | 100 COUNTY ROAD B
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City | SHAWANO
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State | WI
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Zip | 54166-7072
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Country | US
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Telephone | 715-524-2161
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Fax | 715-524-8164
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Provider Business Mailing Address
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Address Line | 415 JEFFERSON ST NORTH TRI-COUNTY HOSPITAL
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City | WADENA
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State | MN
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Zip | 56482-1296
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Country | US
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Telephone | 218-631-3510
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Fax | 218-631-7507
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 68403
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 033503
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 54709
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License Number State | MN
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