Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NN0400X | Neurology | CH2685 | SC |
NPI | 1487619557 |
---|---|
Provider Name | Dr. Adam Stanley Klotzek |
First Address | Minneapolis, MN 55405-2620 |
Second Address | Minneapolis, MN 55405-2620 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
CH2685 | (05) | SC |