Provider Demographics
NPI:1447566906
Name:NICHOLAS P KLOKOCHAR MD PA
Entity Type:Organization
Organization Name:NICHOLAS P KLOKOCHAR MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:KLOKOCHAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-261-4555
Mailing Address - Street 1:2335 TAMIAMI TRL N STE 406
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-4459
Mailing Address - Country:US
Mailing Address - Phone:239-261-4555
Mailing Address - Fax:239-261-6430
Practice Address - Street 1:2335 TAMIAMI TRL N STE 406
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-4459
Practice Address - Country:US
Practice Address - Phone:239-261-4555
Practice Address - Fax:239-261-6430
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-23
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDK462AMedicare PIN