Provider Demographics
NPI:1114280294
Name:KLEE, THERESA (DO)
Entity Type:Individual
Prefix:
First Name:THERESA
Middle Name:
Last Name:KLEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:215 E MANSION ST STE 3E
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MI
Mailing Address - Zip Code:49068-1559
Mailing Address - Country:US
Mailing Address - Phone:269-781-4267
Mailing Address - Fax:269-781-2710
Practice Address - Street 1:215 E MANSION ST STE 3E
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MI
Practice Address - Zip Code:49068-1559
Practice Address - Country:US
Practice Address - Phone:269-781-4267
Practice Address - Fax:269-781-2710
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-22
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101019773208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery