MEDICARE: DOUGLAS B KLIEWER M. D.

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
1	207RG0100X	Gastroenterology Physician	20114	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174518906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOUGLAS B KLIEWER M. D.

Provider Business Mailing Address
First Line	:	PO BOX 305
Second Line	:
City	:	LOWELL
State	:	AR
Zip	:	72745-0305
Country	:	US
Telephone Number	:	918-481-4706
Fax Number	:	918-481-4765

Provider Business Practice Location Address
First Line	:	6465 S YALE AVE
Second Line	:	SUITE 1002
City	:	TULSA
State	:	OK
Zip	:	74136-7812
Country	:	US
Telephone Number	:	918-481-4706
Fax Number	:	918-481-4765

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/19/2005
Last Update Date	:	03/29/2016

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