Provider Demographics
NPI:1043293335
Name:KLEMAWESCH, PATRICK J (MD)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:J
Last Name:KLEMAWESCH
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 1:6294 1 AVE N
Mailing Address - Street 2:
Mailing Address - City:ST. PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-8414
Mailing Address - Country:US
Mailing Address - Phone:727-345-1900
Mailing Address - Fax:727-347-5273
Practice Address - Street 1:6294 - 1ST AVE N
Practice Address - Street 2:ALLERGY ASSOCIATES
Practice Address - City:ST. PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710
Practice Address - Country:US
Practice Address - Phone:727-345-1900
Practice Address - Fax:727-347-5273
Is Sole Proprietor?:No
Enumeration Date:2005-11-21
Last Update Date:2013-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93707207RA0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RA0201XAllopathic & Osteopathic PhysiciansInternal MedicineAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002200500Medicaid
FLCP1792Medicare PIN