Provider Demographics
NPI:1598768418
Name:KLOKOCHAR, NICHOLAS PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:PAUL
Last Name:KLOKOCHAR
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 1:120 FOUNTAINHEAD CT
Mailing Address - Street 2:
Mailing Address - City:LENOIR CITY
Mailing Address - State:TN
Mailing Address - Zip Code:37772-6919
Mailing Address - Country:US
Mailing Address - Phone:239-777-3609
Mailing Address - Fax:865-635-8017
Practice Address - Street 1:120 FOUNTAINHEAD CT
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-6919
Practice Address - Country:US
Practice Address - Phone:239-777-3609
Practice Address - Fax:865-635-8017
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 27720207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78445OtherBC/BS OF FLORIDA
FL78445Medicare ID - Type Unspecified
FL78445OtherBC/BS OF FLORIDA