Provider Demographics
NPI:1619132792
Name:KLASKI, ALBERT LEONARD (MD)
Entity Type:Individual
Prefix:DR
First Name:ALBERT
Middle Name:LEONARD
Last Name:KLASKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2940 N LITCHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-7830
Mailing Address - Country:US
Mailing Address - Phone:623-535-0050
Mailing Address - Fax:623-535-9520
Practice Address - Street 1:2940 N LITCHFIELD RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-7830
Practice Address - Country:US
Practice Address - Phone:623-535-0050
Practice Address - Fax:623-535-9520
Is Sole Proprietor?:No
Enumeration Date:2008-07-28
Last Update Date:2014-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR701542084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ698068Medicaid