Provider Demographics
NPI:1184683310
Name:KLING, JAMIE JOHN (DO)
Entity Type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:JOHN
Last Name:KLING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7974 UW HEALTH CT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETON
Mailing Address - State:WI
Mailing Address - Zip Code:53562-5531
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2977 COUNTY HWY CX
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:WI
Practice Address - Zip Code:53901-9271
Practice Address - Country:US
Practice Address - Phone:608-742-3004
Practice Address - Fax:608-742-2399
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI47104207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1184683310Medicaid
WIK400176428Medicare PIN
WI1184683310Medicaid
WIP00340814Medicare PIN
WI010857155Medicare PIN
WI43531600Medicaid