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1831148261

NPI Code Detail

MEDICARE: JOHN FREDERICK KLINK III M.D.

MEDICARE: JOHN FREDERICK KLINK III 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	2085R0202X	Diagnostic Radiology Physician	26458	KY

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	000000062490	OTHER	KY	ANTHEM BLUE FACET
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1831148261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN FREDERICK KLINK III M.D.

Provider Business Mailing Address
First Line	:	222 S 1ST ST
Second Line	:	SUITE 501
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-5404
Country	:	US
Telephone Number	:	502-583-2731
Fax Number	:	502-583-2733

Provider Business Practice Location Address
First Line	:	200 ABRAHAM FLEXNER WAY
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1818
Country	:	US
Telephone Number	:	502-587-4231
Fax Number	:

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	07/09/2007

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Directions to “ JOHN FREDERICK KLINK III M.D.” Practice Location

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