Provider Demographics
NPI:1699781252
Name:KLA, KOFFI M (MD)
Entity type:Individual
Prefix:DR
First Name:KOFFI
Middle Name:M
Last Name:KLA
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 1:3841 GREEN HILLS VILLAGE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-2691
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1211 21ST AVE S
Practice Address - Street 2:VANDERBILT UNIV MEDICAL CENTER, DEPT OF ANESTHESIOLOGY
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37212-2717
Practice Address - Country:US
Practice Address - Phone:615-936-3779
Practice Address - Fax:615-936-2801
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0066123207L00000X
NC2006-00895207L00000X
TN45455207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC11298OtherRAILROAD MEDICARE GROUP #
MDC11298OtherRAILROAD MEDICARE GROUP #
MDP00447831Medicare PIN
NCI64759Medicare UPIN
MDCA8702Medicare PIN