Provider Demographics
NPI:1477758654
Name:KLEBER, KATHRYN I (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:I
Last Name:KLEBER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7910 W JEFFERSON BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4159
Mailing Address - Country:US
Mailing Address - Phone:260-436-3789
Mailing Address - Fax:260-436-2703
Practice Address - Street 1:7910 W JEFFERSON BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-4159
Practice Address - Country:US
Practice Address - Phone:260-436-3789
Practice Address - Fax:260-436-2703
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-18
Last Update Date:2010-07-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01068480A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN01068480AOtherSTATE LICENSE