Provider Demographics
NPI:1568563575
Name:KLOOSTER, CRAIG PHILLIP (DPM)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:PHILLIP
Last Name:KLOOSTER
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 STONERIDGE MALL RD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588
Mailing Address - Country:US
Mailing Address - Phone:925-460-0681
Mailing Address - Fax:925-460-5158
Practice Address - Street 1:5700 STONERIDGE MALL RD
Practice Address - Street 2:SUITE 120
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588
Practice Address - Country:US
Practice Address - Phone:925-460-0681
Practice Address - Fax:925-460-5158
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3194213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E31943Medicare PIN
T11573Medicare UPIN
CA000E31942Medicare PIN