Provider Demographics
NPI:1134283104
Name:KLOTZ, HENRY M (MD)
Entity Type:Individual
Prefix:
First Name:HENRY
Middle Name:M
Last Name:KLOTZ
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 1:17 LANSING ST
Mailing Address - Street 2:AUBURN MEMORIAL MEDICAL SERVICES, PC
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1983
Mailing Address - Country:US
Mailing Address - Phone:315-255-7438
Mailing Address - Fax:315-255-7099
Practice Address - Street 1:77 NELSON ST
Practice Address - Street 2:SUITE #220
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1944
Practice Address - Country:US
Practice Address - Phone:315-253-5151
Practice Address - Fax:315-253-0841
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2012-12-19
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY154153207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA62685Medicare UPIN
NY42D111Medicare ID - Type Unspecified