Provider Demographics
NPI:1407152416
Name:KLAKEEL, MERRINE (DO)
Entity Type:Individual
Prefix:
First Name:MERRINE
Middle Name:
Last Name:KLAKEEL
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 1:5323 HARRY HINES BLVD
Mailing Address - Street 2:GRADUATE MEDICAL EDUCATION
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75390-9055
Mailing Address - Country:US
Mailing Address - Phone:214-648-0592
Mailing Address - Fax:214-648-9207
Practice Address - Street 1:5323 HARRY HINES BLVD
Practice Address - Street 2:GRADUATE MEDICAL EDUCATION
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75390-9055
Practice Address - Country:US
Practice Address - Phone:214-648-0592
Practice Address - Fax:214-648-9207
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXBP10040289390200000X
TXBP20051408390200000X
TXQ5007208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program