Provider Demographics
NPI:1679524417
Name:KLINGBEIL, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:KLINGBEIL
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9200 W WISCONSIN AVE
Mailing Address - Street 2:PHYSICAL MEDICINE AND REHABILITATION
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3522
Mailing Address - Country:US
Mailing Address - Phone:414-805-7342
Mailing Address - Fax:414-805-7919
Practice Address - Street 1:9200 W WISCONSIN AVE
Practice Address - Street 2:PHYSICAL MEDICINE AND REHABILITATION
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3522
Practice Address - Country:US
Practice Address - Phone:414-805-7342
Practice Address - Fax:414-805-7919
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2014-03-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI27693208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
002000122POtherHUMANA
WI1679524417Medicaid
WI094573601Medicare PIN
WI1679524417Medicaid