Provider Demographics
NPI:1508980699
Name:KLOOSTERMAN, DENNIS JAY (LLP MA)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:JAY
Last Name:KLOOSTERMAN
Suffix:
Gender:M
Credentials:LLP MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 OAKLAND DR FL 3
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-1282
Mailing Address - Country:US
Mailing Address - Phone:269-387-8230
Mailing Address - Fax:269-387-7036
Practice Address - Street 1:1000 OAKLAND DR FL 3
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49008-1282
Practice Address - Country:US
Practice Address - Phone:269-387-8230
Practice Address - Fax:269-387-7036
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301008154174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI325417OtherVALUE OPTIONS INS
MI6223543OtherUNITED BEHAVIORAL HEALTH