Provider Demographics
NPI:1528200482
Name:KLAUSING, ANDREW MICHAEL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:MICHAEL
Last Name:KLAUSING
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 SAINT CLAIR AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT MARYS
Mailing Address - State:OH
Mailing Address - Zip Code:45885-2400
Mailing Address - Country:US
Mailing Address - Phone:419-300-1129
Mailing Address - Fax:419-394-9575
Practice Address - Street 1:801 PRO DR STE D4
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822-3307
Practice Address - Country:US
Practice Address - Phone:419-586-6480
Practice Address - Fax:419-586-4125
Is Sole Proprietor?:No
Enumeration Date:2009-03-24
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002892RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1184652539OtherJTDM FAMILY PRACTICE, LLC GROUP NPI
OH9934723OtherJTDM FAMILY PRACTICE, LLC GROUP MEDICARE PTAN
H409552OtherMEDICARE PTAN
OH0105065OtherJTDM FAMILY PRACTICE, LLC GROUP MEDICAID
OH0075276Medicaid
OH34-1689161OtherJTDM FAMILY PRACTICE, LLC TAX ID