Basic Information
| Provider Information | |||||||||
| NPI: | 1366861148 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLOEFKORN | ||||||||
| FirstName: | CHAD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3367188383 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1706 HAMPTON BLVD APT 2 | ||||||||
| Address2: | |||||||||
| City: | NORFOLK | ||||||||
| State: | VA | ||||||||
| PostalCode: | 235171625 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9193450778 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2014 | ||||||||
| LastUpdateDate: | 02/05/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | BP10049211 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208000000X | BP10049211 | TX | N | Allopathic & Osteopathic Physicians | Pediatrics | 208M00000X | 2017-02242 | NC | Y | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.