Provider Demographics
NPI:1932234952
Name:KLASSEN, MICHAEL G (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:G
Last Name:KLASSEN
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:PO BOX 2019
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93942-2019
Mailing Address - Country:US
Mailing Address - Phone:831-643-9788
Mailing Address - Fax:831-657-0161
Practice Address - Street 1:10 HARRIS CT BLDG A
Practice Address - Street 2:SUITE A1
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-5704
Practice Address - Country:US
Practice Address - Phone:831-643-9788
Practice Address - Fax:831-657-0161
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-22
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69478207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG69478OtherBLUE SHIELD
CAF22373Medicare UPIN
OOG694780Medicare PIN