Provider Demographics
NPI:1659582658
Name:MEDENBACH, KLAUS (MD)
Entity Type:Individual
Prefix:
First Name:KLAUS
Middle Name:
Last Name:MEDENBACH
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 1:1107 14TH AVE SE
Mailing Address - Street 2:SUITE G200
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-3309
Mailing Address - Country:US
Mailing Address - Phone:256-353-0605
Mailing Address - Fax:256-353-0618
Practice Address - Street 1:1107 14TH AVE SE
Practice Address - Street 2:SUITE G200
Practice Address - City:DECATUR
Practice Address - State:AL
Practice Address - Zip Code:35601-3309
Practice Address - Country:US
Practice Address - Phone:256-353-0605
Practice Address - Fax:256-353-0618
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AL8696208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALC76469Medicare UPIN