Provider Demographics
NPI:1295843985
Name:CRAIG P KLOOSTER DPM PC
Entity Type:Organization
Organization Name:CRAIG P KLOOSTER DPM PC
Other - Org Name:FOOT DOCTOR OF PLEASANTON
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:PHILLIP
Authorized Official - Last Name:KLOOSTER
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:925-460-0681
Mailing Address - Street 1:5700 STONERIDGE MALL RD
Mailing Address - Street 2:CRAIG P KLOOSTER DPM PC SUITE 120
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588
Mailing Address - Country:US
Mailing Address - Phone:925-460-0681
Mailing Address - Fax:925-460-5158
Practice Address - Street 1:5700 STONERIDGE MALL RD
Practice Address - Street 2:CRAIG P KLOOSTER DPM PC SUITE 120
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:925-460-0681
Practice Address - Fax:925-460-5158
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2008-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3194213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ06585ZMedicare PIN
T11573Medicare UPIN
CAZZZ06584ZMedicare PIN