MEDICARE: DR. ALEXANDER KLETSEL DDS

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	122300000X	Dentist		IL

General Provider Information

NPI Number	:	1457524795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER KLETSEL DDS

Provider Business Mailing Address
First Line	:	3233 ARLINGTON HTS RD
Second Line	:	SUITE 101
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60004
Country	:	US
Telephone Number	:	847-222-0003
Fax Number	:	847-222-0006

Provider Business Practice Location Address
First Line	:	3233 ARLINGTON HTS RD
Second Line	:	SUITE 101
City	:	ARLINGTON HTS
State	:	IL
Zip	:	60004
Country	:	US
Telephone Number	:	847-222-0003
Fax Number	:	847-222-0006

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

Provider Enumeration Date	:	04/08/2008
Last Update Date	:	04/08/2008

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