Provider Demographics
NPI:1548241094
Name:KLAUER, ROGER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:
Last Name:KLAUER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17343 TURNBURY CT
Mailing Address - Street 2:
Mailing Address - City:GRANGER
Mailing Address - State:IN
Mailing Address - Zip Code:46530-9762
Mailing Address - Country:US
Mailing Address - Phone:574-272-5252
Mailing Address - Fax:
Practice Address - Street 1:60101 BODNAR BLVD
Practice Address - Street 2:SUITE 100B
Practice Address - City:MISHAWAKA
Practice Address - State:IN
Practice Address - Zip Code:46544-9328
Practice Address - Country:US
Practice Address - Phone:574-335-8500
Practice Address - Fax:574-335-0794
Is Sole Proprietor?:No
Enumeration Date:2005-11-10
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01036513A208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000619196OtherBCBS
IN000000607147OtherBCBS
IN000000619196OtherBCBS
IN100090900Medicaid
IN187670DMedicare PIN
INC24554Medicare UPIN
IN257300FMedicare PIN
IN100090900Medicaid