Basic Information
| Provider Information | |||||||||
| NPI: | 1285608265 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLETSCHER | ||||||||
| FirstName: | BRUCE | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1313 E OSBORN RD | ||||||||
| Address2: | SUITE B150 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850145678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022221900 | ||||||||
| FaxNumber: | 6022663870 | ||||||||
| Practice Location | |||||||||
| Address1: | 1313 E OSBORN RD STE 150 | ||||||||
| Address2: | |||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850145688 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6022221900 | ||||||||
| FaxNumber: | 6022663870 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/15/2006 | ||||||||
| LastUpdateDate: | 03/11/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | 24750 | AZ | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.