Provider Demographics
NPI:1699726430
Name:KLECZKA, JAMES F (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:KLECZKA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:DIVISION OF CARDIOLOGY
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-6633
Mailing Address - Fax:414-805-6280
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:DIVISION OF CARDIOLOGY
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-6633
Practice Address - Fax:414-805-6280
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI39082207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
004000215QOtherHUMANA
WI1699726430Medicaid
WI68086 0465Medicare PIN
WI056J 73-601Medicare PIN
WI1699726430Medicaid