MEDICARE: DR. NICHOLAS PAUL KLOKOCHAR 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	207QA0505X	Adult Medicine Physician	ME 27720	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	78445	OTHER	FL	BC/BS OF FLORIDA

General Provider Information

NPI Number	:	1598768418
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS PAUL KLOKOCHAR M.D.

Provider Business Mailing Address
First Line	:	120 FOUNTAINHEAD CT
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6919
Country	:	US
Telephone Number	:	239-777-3609
Fax Number	:

Provider Business Practice Location Address
First Line	:	120 FOUNTAINHEAD CT
Second Line	:
City	:	LENOIR CITY
State	:	TN
Zip	:	37772-6919
Country	:	US
Telephone Number	:	239-777-3609
Fax Number	:

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

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	11/19/2024

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