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General NPI Number Information
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NPI Number | 1669975470
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Entity Type | Individual
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Provider Name | NED KLETZ MD
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Gender | Male
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Dates
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Enumeration Date | 03/18/2018
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Last Update Date | 01/10/2025
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Provider Practice Location Address
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Address Line | 1287 FULTON RD
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City | SANTA ROSA
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State | CA
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Zip | 95401-4923
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Country | US
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Telephone | 707-800-7700
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Fax | 707-800-7797
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Provider Business Mailing Address
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Address Line | 1450 W LONG LAKE RD STE 340
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City | TROY
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State | MI
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Zip | 48098-6330
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Country | US
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Telephone | 248-905-5091
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Fax | 248-905-5096
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | A177089
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License Number State | CA
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