Provider Demographics
NPI:1154696029
Name:KLEEHAMMER, DANIEL G (PA)
Entity type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:G
Last Name:KLEEHAMMER
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:601 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-9349
Mailing Address - Country:US
Mailing Address - Phone:585-273-3125
Mailing Address - Fax:
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 665
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642
Practice Address - Country:US
Practice Address - Phone:585-273-3125
Practice Address - Fax:585-273-3669
Is Sole Proprietor?:No
Enumeration Date:2012-03-12
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NY15499363A00000X
NY015499363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant