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NPI Code Detail

MEDICARE: KURT J KLISE MD

MEDICARE: KURT J KLISE MD
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
1207Q00000XFamily Medicine Physician24439IA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1080195357OTHERIARR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1871589754
Entity Type Code : Individual
Provider Name (Legal Business Name) : KURT J KLISE MD
Provider Business Mailing Address
First Line : PO BOX 1475
Second Line :
City : DES MOINES
State : IA
Zip : 50305-1475
Country : US
Telephone Number : 515-300-3900
Fax Number : 515-300-3901
Provider Business Practice Location Address
First Line : 250 SW BROOKSIDE DR
Second Line :
City : GRIMES
State : IA
Zip : 50111-4900
Country : US
Telephone Number : 515-300-3900
Fax Number : 515-300-3901
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2005
Last Update Date : 03/17/2018

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