MEDICARE: A KLAS ASSOCIATION

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	207QA0505X	Adult Medicine Physician	01038707A	IN

General Provider Information

NPI Number	:	1477820017
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	A KLAS ASSOCIATION

Provider Business Mailing Address
First Line	:	1829 BRASSICA LN
Second Line	:	BLGD. A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-7095
Country	:	US
Telephone Number	:	317-698-6883
Fax Number	:	317-708-2695

Provider Business Practice Location Address
First Line	:	1829 BRASSICA LN
Second Line	:	BLGD. A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-7095
Country	:	US
Telephone Number	:	317-698-6883
Fax Number	:	317-708-2695

Authorized Official
Title or Position	:	SENIOR PARTNER
Name	:	DR. ALEXANDER KLAZ
Credential	:	MD
Telephone Number	:	317-698-6883

Provider Enumeration Date	:	11/28/2011
Last Update Date	:	10/18/2013

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