Provider Demographics
NPI:1528300670
Name:FREDERICK R KLEPSCH MD PC
Entity type:Organization
Organization Name:FREDERICK R KLEPSCH MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:LORRIE
Authorized Official - Middle Name:S
Authorized Official - Last Name:THIEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-661-1592
Mailing Address - Street 1:2050 N MAIN ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2035
Mailing Address - Country:US
Mailing Address - Phone:219-661-0196
Mailing Address - Fax:219-661-1593
Practice Address - Street 1:2050 N MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-2035
Practice Address - Country:US
Practice Address - Phone:219-661-0196
Practice Address - Fax:219-661-1593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-26
Last Update Date:2013-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01026277261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200008820Medicaid
IND94869Medicare UPIN
IN877600Medicare PIN