MEDICARE: DR. LEE KLOPFENSTEIN 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	207Q00000X	Family Medicine Physician	01036887A	IN
2	207Q00000X	Family Medicine Physician	35-056978	OH

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	:	1184729220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LEE KLOPFENSTEIN M.D.

Provider Business Mailing Address
First Line	:	7360 SALISBURY RD
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-9612
Country	:	US
Telephone Number	:	419-263-8328
Fax Number	:	567-343-7298

Provider Business Practice Location Address
First Line	:	1715 INDIAN WOOD CIR STE OFFICE
Second Line	:
City	:	MAUMEE
State	:	OH
Zip	:	43537-4055
Country	:	US
Telephone Number	:	419-578-8594
Fax Number	:

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	02/08/2022

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