Provider Demographics
NPI:1386996080
Name:KLOSTERMANN, ISAAC J (PA-C)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:J
Last Name:KLOSTERMANN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 E. NIAGARA ROAD
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-5027
Mailing Address - Country:US
Mailing Address - Phone:970-497-4921
Mailing Address - Fax:855-855-4482
Practice Address - Street 1:1550 E. NIAGARA ROAD
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-5027
Practice Address - Country:US
Practice Address - Phone:970-497-4921
Practice Address - Fax:855-855-4482
Is Sole Proprietor?:No
Enumeration Date:2012-10-05
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003531363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO63020254Medicaid
CO497750ZPR5OtherMEDICARE B PTAN FOR PEAK FAMILY MEDICINE
COP01653177OtherRAILROAD WORKERS MEDICARE FOR PEAK FAMILY MEDICINE