Provider Demographics
NPI:1083698682
Name:KLAUSNER, MITCHELL E (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:E
Last Name:KLAUSNER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:30840 NORTHWESTERN HWY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2552
Mailing Address - Country:US
Mailing Address - Phone:248-932-8725
Mailing Address - Fax:248-932-8977
Practice Address - Street 1:30840 NORTHWESTERN HWY
Practice Address - Street 2:SUITE 300
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2552
Practice Address - Country:US
Practice Address - Phone:248-932-8725
Practice Address - Fax:248-932-8977
Is Sole Proprietor?:No
Enumeration Date:2005-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301075569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0828603OtherBCBS INDIVIDUAL
MI4401625Medicaid
MI0828603OtherBCBS INDIVIDUAL
MIH15371Medicare UPIN