Provider Demographics
NPI:1063412922
Name:KLEANTHOUS, JAMES KLEO (DPM)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:KLEO
Last Name:KLEANTHOUS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:140 W. MIDDLE STREET
Mailing Address - Street 2:SUITE B
Mailing Address - City:CHELSEA
Mailing Address - State:MI
Mailing Address - Zip Code:48118-1293
Mailing Address - Country:US
Mailing Address - Phone:734-433-2397
Mailing Address - Fax:734-433-2655
Practice Address - Street 1:140 W. MIDDLE STREET
Practice Address - Street 2:SUITE B
Practice Address - City:CHELSEA
Practice Address - State:MI
Practice Address - Zip Code:48118-1293
Practice Address - Country:US
Practice Address - Phone:734-433-2397
Practice Address - Fax:734-433-2655
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2022-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001892213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N67820Medicare ID - Type Unspecified
U55514Medicare UPIN