MEDICARE: DR. ROBERT JOHN KLOTZ PHD, PSYS, MSW, LMSW

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	1041C0700X	Clinical Social Worker		MI

General Provider Information

NPI Number	:	1871702217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT JOHN KLOTZ PHD, PSYS, MSW, LMSW

Provider Business Mailing Address
First Line	:	1032 N MAPLE AVE
Second Line	:
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-1220
Country	:	US
Telephone Number	:	248-544-6831
Fax Number	:	248-544-1267

Provider Business Practice Location Address
First Line	:	25600 WOODWARD AVE.
Second Line	:	SUITE 205
City	:	ROYAL OAK
State	:	MI
Zip	:	48067-0945
Country	:	US
Telephone Number	:	248-584-3332
Fax Number	:	248-584-3334

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

Provider Enumeration Date	:	05/22/2007
Last Update Date	:	07/08/2007

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