MEDICARE: GREGORY C. KLOEHN 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	207RI0011X	Interventional Cardiology Physician	35-07-8422	OH
2	207RI0011X	Interventional Cardiology Physician	ME139561	FL

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1740269711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY C. KLOEHN M.D.

Provider Business Mailing Address
First Line	:	2964 N STATE ROAD 7 STE 110
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-5715
Country	:	US
Telephone Number	:	954-975-3102
Fax Number	:	954-973-1882

Provider Business Practice Location Address
First Line	:	2964 N STATE ROAD 7 STE 110
Second Line	:
City	:	MARGATE
State	:	FL
Zip	:	33063-5715
Country	:	US
Telephone Number	:	954-975-3102
Fax Number	:	954-973-1882

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

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	12/29/2020

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