Basic Information
| Provider Information | |||||||||
| NPI: | 1497849012 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLEVAY | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | JOHN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2854 HIGHWAY 55 STE 130 | ||||||||
| Address2: | |||||||||
| City: | EAGAN | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551211447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6518423349 | ||||||||
| FaxNumber: | 6518423391 | ||||||||
| Practice Location | |||||||||
| Address1: | 1959 SLOAN PL | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SAINT PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551172086 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6517726235 | ||||||||
| FaxNumber: | 6517726261 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2006 | ||||||||
| LastUpdateDate: | 11/09/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 36203 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RI0200X | 36203 | IA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | 207RI0200X | 51734 | MN | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 1497849012 | 05 | IA | MEDICAID |