Provider Demographics
NPI:1578537031
Name:MERGENER, KLAUS D (MD)
Entity Type:Individual
Prefix:
First Name:KLAUS
Middle Name:D
Last Name:MERGENER
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 1:820 N CHELAN AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2028
Mailing Address - Country:US
Mailing Address - Phone:509-663-8711
Mailing Address - Fax:
Practice Address - Street 1:840 E HILL AVE
Practice Address - Street 2:
Practice Address - City:MOSES LAKE
Practice Address - State:WA
Practice Address - Zip Code:98837-2238
Practice Address - Country:US
Practice Address - Phone:509-663-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039380207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA781604Medicaid
WAMD00039380OtherWA LICENSE
WAAB38058Medicare PIN
WAG8851597Medicare PIN
WA000188100Medicare PIN
WAG8851594Medicare PIN
WA781604Medicaid
WAG8851595Medicare PIN
WAMD00039380OtherWA LICENSE
WAP00275525Medicare PIN
WAG8880511Medicare PIN
WAG8851596Medicare PIN
WA001045700Medicare PIN