Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 170100000X | Medical Geneticist | 01030319 | IN |
Y | 207Q00000X | Family Doctor | 01030319A | IN |
NPI | 1992806194 |
---|---|
Provider Name | William Clayton Kleckner |
First Address | Indianapolis, IN 46268-3129 |
Second Address | Indianapolis, IN 46256-1467 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 02/04/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
100074110 | (05) | IN |