Provider Demographics
NPI:1518950153
Name:KLEVEN, KRISTINA ANN (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:ANN
Last Name:KLEVEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2607 N GRANDVIEW BLVD
Mailing Address - Street 2:STE 125
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1756
Mailing Address - Country:US
Mailing Address - Phone:414-290-4540
Mailing Address - Fax:262-754-4940
Practice Address - Street 1:13800 W NORTH AVE
Practice Address - Street 2:STE 100
Practice Address - City:BROOKFIELD
Practice Address - State:WI
Practice Address - Zip Code:53005-4974
Practice Address - Country:US
Practice Address - Phone:262-754-4488
Practice Address - Fax:262-754-4940
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI44946020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI$$$$$$$$$001OtherBLUE CROSS BLUE SHIELD
I28352Medicare UPIN
WI000902325Medicare PIN
WI000168449Medicare PIN
WI$$$$$$$$$001OtherBLUE CROSS BLUE SHIELD
WI000568308Medicare PIN