Basic Information
| Provider Information | |||||||||
| NPI: | 1700175593 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MITCHELL KLAUSNER MD PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3061 CHRISTY WAY | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486032224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9897912455 | ||||||||
| FaxNumber: | 9897911392 | ||||||||
| Practice Location | |||||||||
| Address1: | 25260 LATHRUP ST | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480751923 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2489321250 | ||||||||
| FaxNumber: | 2489321250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2011 | ||||||||
| LastUpdateDate: | 04/01/2011 | ||||||||
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| AuthorizedOfficialLastName: | KLAUSNER | ||||||||
| AuthorizedOfficialFirstName: | MITCHELL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2489321250 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301075369 | MI | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.