Provider Demographics
NPI:1679538326
Name:KLIESCH, JOHN F (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:F
Last Name:KLIESCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 9
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37662-0009
Mailing Address - Country:US
Mailing Address - Phone:423-857-2066
Mailing Address - Fax:423-857-2070
Practice Address - Street 1:105 W STONE DR
Practice Address - Street 2:STE 1F
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3365
Practice Address - Country:US
Practice Address - Phone:423-230-2420
Practice Address - Fax:423-230-2422
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MS15513207Q00000X
TNMD53100207Q00000X
NC2007-01282207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSG91664Medicare UPIN