MEDICARE: MR. SCOTT ALLEN KLAES C.S.A.

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	363AS0400X	Surgical Physician Assistant

General Provider Information

NPI Number	:	1336479351
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SCOTT ALLEN KLAES C.S.A.

Provider Business Mailing Address
First Line	:	1420 16TH AVE NW
Second Line	:
City	:	ROCHESTER
State	:	MN
Zip	:	55901-0254
Country	:	US
Telephone Number	:	507-990-2921
Fax Number	:

Provider Business Practice Location Address
First Line	:	201 W CENTER ST
Second Line	:	EI-01 SUGICAL ASSISTANTS
City	:	ROCHESTER
State	:	MN
Zip	:	55902-3003
Country	:	US
Telephone Number	:	507-266-2827
Fax Number	:	507-266-1978

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

Provider Enumeration Date	:	01/14/2010
Last Update Date	:	01/14/2010

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