Provider Demographics
NPI:1205814217
Name:KLENK, SUSAN L (MD)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:L
Last Name:KLENK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8674
Mailing Address - Street 2:MANKATO CLINIC LTD 1230 E. MAIN STREET
Mailing Address - City:MANKATO
Mailing Address - State:MN
Mailing Address - Zip Code:56002-8674
Mailing Address - Country:US
Mailing Address - Phone:507-625-1811
Mailing Address - Fax:
Practice Address - Street 1:1901 OLD MINNESOTA AVE
Practice Address - Street 2:MANKATO CLINIC @ DANIELS HEALTH CENTER
Practice Address - City:ST PETER
Practice Address - State:MN
Practice Address - Zip Code:56048
Practice Address - Country:US
Practice Address - Phone:507-934-2325
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2020-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN46021207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1965902OtherAMERICAS PPO
MN0114694OtherMEDICA
MN098K8KLOtherBCBS
MN711192400Medicaid
P00040739OtherRR MEDICARE
MNHP39271OtherHEALTH PARTNERS
MNNA2951035036OtherPREFERRED ONE
MN171841OtherUCARE
410849339 56001 C207OtherCHAMPUS
P00040739OtherRR MEDICARE
MN711192400Medicaid