Provider Demographics
NPI:1265653182
Name:DAVID KLIMEK PHD PC
Entity Type:Organization
Organization Name:DAVID KLIMEK PHD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CHIEF PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:KLIMEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:734-995-0999
Mailing Address - Street 1:2200 FULLER CT
Mailing Address - Street 2:SUITE 1101B
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2311
Mailing Address - Country:US
Mailing Address - Phone:734-995-0999
Mailing Address - Fax:
Practice Address - Street 1:2200 FULLER CT
Practice Address - Street 2:SUITE 1101B
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2311
Practice Address - Country:US
Practice Address - Phone:734-995-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2014-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68OH14967OtherPSYCHOLOGIST
MI0M10560Medicare ID - Type UnspecifiedLICENSED PSYCHOLOGIST