Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 54709 | MN |
N | 208600000X | Surgeon | 54709 | MN |
Y | 208200000X | Surgeon | 68403 | WI |
Y | 208600000X | Surgeon | 68403 | WI |
NPI | 1003842915 |
---|---|
Provider Name | Mr. David A Kloss |
First Address | Wadena, MN 56482-1296 |
Second Address | Shawano, WI 54166-7072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/06/2006 |
Last Update Date | 05/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001335034 | (05) | CT |
001335034 | BLUE CARE FAMILY PLAN (01) | CT |
010033503CT01 | ANTHEM BC / BS (01) | CT |
030515 | HEALTHNET (01) | CT |
0706347 | AETNA / US HEALTHCARE (01) | CT |
1144213006 | CIGNA (01) | CT |
335030 | CONNECTICARE (01) | CT |
F73498 | (02) | |
F73498 | (02) | CT |
P02113 | CHA (01) | CT |
WIS020 | OXFORD (01) | CT |