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NPI Code Detail

MEDICARE: JOSEPH MICHAEL KLICK CRNA

MEDICARE:   JOSEPH MICHAEL KLICK  CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistR0799010MN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
127G81KLOTHERMNBLUE CROSS MN
2430056096OTHERMNPALMETTO GBA RR MC
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
42552OTHERMNARAZ
5143425200OTHERMNUS DEPARTMENT OF LABOR
61103036OTHERMNARAZ

General Provider Information

NPI Number : 1073516266
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOSEPH MICHAEL KLICK CRNA
Provider Business Mailing Address
First Line : 400 E 10TH ST
Second Line :
City : WACONIA
State : MN
Zip : 55387-4552
Country : US
Telephone Number : 952-442-9770
Fax Number : 952-442-3620
Provider Business Practice Location Address
First Line : 717 S STATE ST
Second Line : STE 100
City : FAIRMONT
State : MN
Zip : 56031-4470
Country : US
Telephone Number : 507-235-3939
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/23/2005
Last Update Date : 04/28/2008

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Directions to “ JOSEPH MICHAEL KLICK CRNA” Practice Location

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