Provider Demographics
NPI:1093919664
Name:KLIMISCH, JUSTIN JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:JOHN
Last Name:KLIMISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5917 CROSSTOWN EXPRESSWAY SH 286
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78417
Mailing Address - Country:US
Mailing Address - Phone:361-854-0811
Mailing Address - Fax:361-806-5040
Practice Address - Street 1:5917 CROSSTOWN EXPRESSWAY SH 286
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78417
Practice Address - Country:US
Practice Address - Phone:361-854-0811
Practice Address - Fax:361-806-5040
Is Sole Proprietor?:No
Enumeration Date:2007-06-14
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN2602207XS0114X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX313657401Medicaid
WA0263320OtherL&I
WA0263320OtherL&I