Provider Demographics
NPI:1316243355
Name:KLADA, EMILE
Entity type:Individual
Prefix:
First Name:EMILE
Middle Name:
Last Name:KLADA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7760 HONEYSUCKLE LN
Mailing Address - Street 2:
Mailing Address - City:MAUMEE
Mailing Address - State:OH
Mailing Address - Zip Code:43537-9185
Mailing Address - Country:US
Mailing Address - Phone:551-358-8143
Mailing Address - Fax:
Practice Address - Street 1:5700 MONROE ST UNIT 308
Practice Address - Street 2:
Practice Address - City:SYLVANIA
Practice Address - State:OH
Practice Address - Zip Code:43560-2768
Practice Address - Country:US
Practice Address - Phone:419-291-7555
Practice Address - Fax:419-479-2696
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.121278207RC0200X, 207RP1001X
MI4301104018207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1316243355Medicaid
OH0086923Medicaid