Provider Demographics
NPI:1609818111
Name:KLOKEID, BRIAN G (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:G
Last Name:KLOKEID
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:PO BOX 51
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10163-0051
Mailing Address - Country:US
Mailing Address - Phone:206-399-6544
Mailing Address - Fax:
Practice Address - Street 1:415 E 37TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-3200
Practice Address - Country:US
Practice Address - Phone:206-399-6544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY270872207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0227518OtherLIWA
WA0202697OtherLIWA
WA8081KLOtherBSWA
WA605960013OtherUSDLAB
WA8296014Medicaid
WA1450KLOtherBSWA
WA8296014Medicaid
WA930117735Medicare PIN
WAG8856289Medicare PIN
WAG8870070Medicare PIN
WA0202697OtherLIWA