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General NPI Number Information
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NPI Number | 1144457169
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Entity Type | Individual
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Provider Name | BRIAN KLOSTERMANN MD
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Gender | Male
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Dates
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Enumeration Date | 06/17/2009
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Last Update Date | 12/22/2021
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Provider Practice Location Address
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Address Line | 12860 TROXLER AVE
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City | HIGHLAND
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State | IL
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Zip | 62249-2898
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Country | US
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Telephone | 618-651-2810
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Fax | 618-651-0077
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Provider Business Mailing Address
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Address Line | 5100 RELIABLE PKWY
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City | CHICAGO
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State | IL
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Zip | 60686-0001
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Country | US
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Telephone | 309-672-4809
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Fax |
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 036129725
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 036129725
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License Number State | IL
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