Provider Demographics
NPI:1356453450
Name:KLAUTKY, STEPHEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:KLAUTKY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 W CEDAR ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44307-2400
Mailing Address - Country:US
Mailing Address - Phone:330-376-0500
Mailing Address - Fax:330-376-9900
Practice Address - Street 1:185 W CEDAR ST
Practice Address - Street 2:SUITE 100
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44307-2400
Practice Address - Country:US
Practice Address - Phone:330-376-0500
Practice Address - Fax:330-376-9900
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3588401207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2682468Medicaid
OH2682468Medicaid
OH4189654Medicare PIN