Provider Demographics
NPI:1467418285
Name:KLEMME, JAY C (MD)
Entity Type:Individual
Prefix:
First Name:JAY
Middle Name:C
Last Name:KLEMME
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 1:1874 CLEVELAND RD
Mailing Address - Street 2:
Mailing Address - City:WOOSTER
Mailing Address - State:OH
Mailing Address - Zip Code:44691-2263
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11100 EUCLID AVENUE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-844-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35052120207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0783666Medicaid
OH000000550699OtherANTHEM
OH4479379OtherAETNA
OH734158OtherBUCKEYE
KL0658923OtherMEDICARE ID
OH421807OtherWELLCARE
OH000000230992OtherUNISON
OH0783666Medicaid
OH000000550699OtherANTHEM
OHE76021Medicare UPIN
OHKL0658923Medicare PIN