Provider Demographics
NPI:1013019579
Name:KLEMA, JOHN WILLIAM III (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:KLEMA
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4963 B NE GOODVIEW CIRCLE
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64064
Mailing Address - Country:US
Mailing Address - Phone:816-795-7100
Mailing Address - Fax:816-795-7105
Practice Address - Street 1:4963 NE GOODVIEW CIR STE B
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2491
Practice Address - Country:US
Practice Address - Phone:816-795-7100
Practice Address - Fax:816-795-7105
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-03
Last Update Date:2010-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR9142207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO241071109Medicaid
MO8580000Medicare ID - Type Unspecified
MO241071109Medicaid