Provider Demographics
NPI:1215906375
Name:KLINGER, DEAN E (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:E
Last Name:KLINGER
Suffix:
Gender:M
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:W129N7055 NORTHFIELD DR
Mailing Address - Street 2:COMMUNITY MEMORIAL MEDICAL COMMONS
Mailing Address - City:MENOMONEE FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:53051-0538
Mailing Address - Country:US
Mailing Address - Phone:262-253-5400
Mailing Address - Fax:262-253-3339
Practice Address - Street 1:W129N7055 NORTHFIELD DR
Practice Address - Street 2:COMMUNITY MEMORIAL MEDICAL COMMONS
Practice Address - City:MENOMONEE FALLS
Practice Address - State:WI
Practice Address - Zip Code:53051-0538
Practice Address - Country:US
Practice Address - Phone:262-253-5400
Practice Address - Fax:262-253-3339
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI23801208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30723200Medicaid
WI1215906375Medicaid
WIB54201Medicare UPIN
WI30723200Medicaid
WI73445-0003Medicare ID - Type Unspecified
WI73601 1371Medicare PIN