Provider Demographics
NPI:1497819072
Name:KLAFT, COLENE JUDITH (PA-C)
Entity Type:Individual
Prefix:MS
First Name:COLENE
Middle Name:JUDITH
Last Name:KLAFT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:COLLEEN
Other - Middle Name:JUDITH
Other - Last Name:KLAFT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:915 E 5TH STREET
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48067
Mailing Address - Country:US
Mailing Address - Phone:248-542-0568
Mailing Address - Fax:313-916-1239
Practice Address - Street 1:3031 W GRAND BLVD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48202-3046
Practice Address - Country:US
Practice Address - Phone:313-916-2454
Practice Address - Fax:313-916-1239
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601001803363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical