Provider Demographics
NPI:1508834672
Name:KLIM, JOHN PETER (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PETER
Last Name:KLIM
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18077 RIVER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:NOBLESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46062-8334
Mailing Address - Country:US
Mailing Address - Phone:317-776-7028
Mailing Address - Fax:317-773-7910
Practice Address - Street 1:18077 RIVER RD STE 200
Practice Address - Street 2:
Practice Address - City:NOBLESVILLE
Practice Address - State:IN
Practice Address - Zip Code:46062-8334
Practice Address - Country:US
Practice Address - Phone:317-776-7028
Practice Address - Fax:317-773-7910
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02002790A207L00000X, 207LA0401X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000712623OtherANTHEM
IN200462270Medicaid
IN11492492OtherCAQH
IN000000360265OtherANTHEM PROVIDER NUMBER
IN815140IMedicare ID - Type Unspecified
IN11492492OtherCAQH