Provider Demographics
NPI:1619531118
Name:KLIMEK, THEODORE JOSEPH (MD)
Entity Type:Individual
Prefix:
First Name:THEODORE
Middle Name:JOSEPH
Last Name:KLIMEK
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 1:2215 E LAKE ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55407-4385
Mailing Address - Country:US
Mailing Address - Phone:612-596-9438
Mailing Address - Fax:612-329-4500
Practice Address - Street 1:2215 E LAKE ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-4385
Practice Address - Country:US
Practice Address - Phone:612-596-9438
Practice Address - Fax:612-329-4500
Is Sole Proprietor?:No
Enumeration Date:2019-04-30
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN739112084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry