MEDICARE: DR. ALEXANDER KLAZ 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	207Q00000X	Family Medicine Physician	01038707	IN

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

General Provider Information

NPI Number	:	1811989882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER KLAZ M.D.

Provider Business Mailing Address
First Line	:	1829 BRASSICA LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-7095
Country	:	US
Telephone Number	:	317-698-6883
Fax Number	:	317-782-1069

Provider Business Practice Location Address
First Line	:	1829 BRASSICA LN
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46217-7095
Country	:	US
Telephone Number	:	317-698-6883
Fax Number	:	317-782-1069

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

Provider Enumeration Date	:	08/16/2005
Last Update Date	:	09/25/2016

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