Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 00953 | MD |
Y | 222Z00000X | Podiatrist | 00953 | MD |
NPI | 1003891375 |
---|---|
Provider Name | Dr. Lewis Klotzman |
First Address | Baltimore, MD 21212-3028 |
Second Address | Baltimore, MD 21212-3028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/12/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
429248100 | (05) | MD |
T59879 | (02) |