Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 42466 | WI |
N | 111NI0900X | Internist | 42466 | WI |
N | 207RH0002X | Hospice and Palliative Medicine | 42466 | WI |
Y | 207RH0002X | Hospice and Palliative Medicine | 49169 | MN |
NPI | 1144226481 |
---|---|
Provider Name | Thomas J Klemond |
First Address | Minneapolis, MN 55415-1623 |
Second Address | Minneapolis, MN 55415-1623 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2005 |
Last Update Date | 02/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
34022600 | (05) | WI |
H24678 | (02) |