Provider Demographics
NPI:1033312723
Name:KLEMCZAK, DENISE L (DO)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:L
Last Name:KLEMCZAK
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1160 CYPRESS GLEN CIR
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-7560
Mailing Address - Country:US
Mailing Address - Phone:407-518-1993
Mailing Address - Fax:407-518-9056
Practice Address - Street 1:1160 CYPRESS GLEN CIR
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-7560
Practice Address - Country:US
Practice Address - Phone:407-518-1993
Practice Address - Fax:407-518-9056
Is Sole Proprietor?:No
Enumeration Date:2007-06-08
Last Update Date:2013-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036118539207V00000X
FLOS12104207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036118539OtherILLINOIS LICENSE
FL009224600Medicaid
IL036118539Medicaid
FL009224600Medicaid
IL036118539Medicaid