Provider Demographics
NPI:1497953533
Name:KLAMO, RACHEL MARYANN (DO)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:MARYANN
Last Name:KLAMO
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 1:72 SOUTH WASHINGTON ST.
Mailing Address - Street 2:SUITE 204
Mailing Address - City:OXFORD
Mailing Address - State:MI
Mailing Address - Zip Code:48371
Mailing Address - Country:US
Mailing Address - Phone:248-628-2233
Mailing Address - Fax:248-628-2384
Practice Address - Street 1:72 SOUTH WASHINGTON ST.
Practice Address - Street 2:SUITE 204
Practice Address - City:OXFORD
Practice Address - State:MI
Practice Address - Zip Code:48371
Practice Address - Country:US
Practice Address - Phone:248-628-2233
Practice Address - Fax:248-628-2384
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2020-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125052054207Q00000X
MI5101022084207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
821050OtherGROUP MEDICARE PTAN