Provider Demographics
NPI:1225132319
Name:KLEINKLAUS-LEE, AMY (DO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KLEINKLAUS-LEE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 W LAKE COOK RD
Mailing Address - Street 2:STE 120
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2089
Mailing Address - Country:US
Mailing Address - Phone:847-808-8884
Mailing Address - Fax:847-808-8890
Practice Address - Street 1:600 W LAKE COOK RD
Practice Address - Street 2:STE 120
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2089
Practice Address - Country:US
Practice Address - Phone:847-808-8884
Practice Address - Fax:847-808-8890
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2013-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036122953207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
061483728OtherHMC
1225132319OtherNPI
IL531880002OtherPTAN
040040160CT01OtherBCCT
061483728OtherNEDH
061483728OtherONE
061483728OtherNYGE
1710959721OtherNPI GROUP NUMBER
P2647139OtherOHP
061483728OtherCHCR
061483728OtherFIRH
061483728OtherCGNA
061483728OtherHLCT
061483728OtherMULT
160002038OtherMCR
2V1497OtherHNET
401600OtherCTCR
061483728OtherGRWE
061483728OtherPHCS
061483728OtherPOMC
2861803OtherATNA
061483728OtherHLCT
061483728OtherCGNA