Provider Demographics
NPI:1194743070
Name:KLASINSKI, MICHELE M (MD)
Entity type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:M
Last Name:KLASINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 VINCENT ST
Mailing Address - Street 2:
Mailing Address - City:STEVENS POINT
Mailing Address - State:WI
Mailing Address - Zip Code:54481-1842
Mailing Address - Country:US
Mailing Address - Phone:715-344-0701
Mailing Address - Fax:715-344-4494
Practice Address - Street 1:500 VINCENT ST
Practice Address - Street 2:
Practice Address - City:STEVENS POINT
Practice Address - State:WI
Practice Address - Zip Code:54481-1842
Practice Address - Country:US
Practice Address - Phone:715-344-0701
Practice Address - Fax:715-344-4494
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI270092084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI200010904OtherRAILROAD MEDICARE PROVIDER NUMBER
WI30670500Medicaid
B54173Medicare UPIN
WI200010904OtherRAILROAD MEDICARE PROVIDER NUMBER
WI30670500Medicaid