Provider Demographics
NPI:1376526467
Name:KLOTT, CARLO (MD)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:
Last Name:KLOTT
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 1:800 E HIGHWAY 71
Mailing Address - Street 2:
Mailing Address - City:SMITHVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78957-1730
Mailing Address - Country:US
Mailing Address - Phone:512-237-3214
Mailing Address - Fax:512-237-5768
Practice Address - Street 1:800 E HIGHWAY 71
Practice Address - Street 2:
Practice Address - City:SMITHVILLE
Practice Address - State:TX
Practice Address - Zip Code:78957
Practice Address - Country:US
Practice Address - Phone:512-237-3214
Practice Address - Fax:512-237-5768
Is Sole Proprietor?:No
Enumeration Date:2005-11-22
Last Update Date:2018-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1294207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX124361006Medicaid
TXB24017Medicare UPIN