Basic Information
Provider Information
NPI: 1194881680
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: KLAUER
FirstName: KEVIN
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: DO
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4535 DRESSLER RD NW
Address2:  
City: CANTON
State: OH
PostalCode: 447182545
CountryCode: US
TelephoneNumber: 3304934443
FaxNumber: 3304938677
Practice Location
Address1: 5100 W BROAD ST
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432281607
CountryCode: US
TelephoneNumber: 3304934443
FaxNumber: 3304938677
Other Information
ProviderEnumerationDate: 12/29/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207P00000X34.006464OHY Allopathic & Osteopathic PhysiciansEmergency Medicine 

No ID Information.


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