Provider Demographics
NPI:1063445138
Name:KLEEMAN, MICHAEL W (DO)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:W
Last Name:KLEEMAN
Suffix:
Gender:M
Credentials:DO
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Other - Last Name:
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Mailing Address - Street 1:250 PATCHOGUE YAPHANK RD
Mailing Address - Street 2:SUITE 11 B
Mailing Address - City:EAST PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-4800
Mailing Address - Country:US
Mailing Address - Phone:631-475-5051
Mailing Address - Fax:631-475-8268
Practice Address - Street 1:250 PATCHOGUE YAPHANK RD
Practice Address - Street 2:SUITE 11 B
Practice Address - City:EAST PATCHOGUE
Practice Address - State:NY
Practice Address - Zip Code:11772-4800
Practice Address - Country:US
Practice Address - Phone:631-475-5051
Practice Address - Fax:631-475-8268
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-01-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY240507208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2356468OtherCIGNA
NY2573801OtherUNITED HEALTHCARE
NY7982701OtherAETNA
NY0126239OtherGHI
NY336380POtherHIP
NYP3716058OtherOXFORD
NY336381OtherVYTRA
NY336400OtherVYTRA
NYP00345437OtherRAILROAD MEDICARE
NY4S6531OtherEMPIRE BCBS
NY02797813Medicaid
NY0126239OtherGHI
NY336400OtherVYTRA