Provider Demographics
NPI:1104852797
Name:KLOSTERMANN, ERIC J (DPM)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:J
Last Name:KLOSTERMANN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3129
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-3129
Mailing Address - Country:US
Mailing Address - Phone:310-792-3914
Mailing Address - Fax:855-898-4055
Practice Address - Street 1:4560 ADMIRALTY WAY
Practice Address - Street 2:SUITE 351
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5426
Practice Address - Country:US
Practice Address - Phone:310-792-3914
Practice Address - Fax:855-898-4055
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE-1993213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E19931Medicaid
CA000E19930OtherBLUE SHIELD
CA000E19931Medicaid
CAT11123Medicare UPIN
CA5280900001Medicare NSC