Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | 5901001892 | MI |
Y | 222Z00000X | Podiatrist | 5901001892 | MI |
NPI | 1063412922 |
---|---|
Provider Name | James Kleo Kleanthous |
First Address | Chelsea, MI 48118-1628 |
Second Address | Chelsea, MI 48118-1628 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2005 |
Last Update Date | 02/04/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U55514 | (02) |