Provider Demographics
NPI:1659332195
Name:KLOBASA, CHARLES LOUIS (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:LOUIS
Last Name:KLOBASA
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 1:225 SOUTHWIND PLACE
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN
Mailing Address - State:KS
Mailing Address - Zip Code:66503
Mailing Address - Country:US
Mailing Address - Phone:785-776-5858
Mailing Address - Fax:785-776-6152
Practice Address - Street 1:225 SOUTHWIND PLACE
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66503
Practice Address - Country:US
Practice Address - Phone:785-776-5858
Practice Address - Fax:785-776-6152
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04186202084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
B68678Medicare UPIN
002157Medicare ID - Type Unspecified