Provider Demographics
NPI:1689662504
Name:KLEYKAMP, DONALD L (MD)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:L
Last Name:KLEYKAMP
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 1:27 CENTENNIAL DR
Mailing Address - Street 2:INTERNAL MEDICINE PHYSICIANS OF THE NORTH SHORE
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7901
Mailing Address - Country:US
Mailing Address - Phone:978-531-7677
Mailing Address - Fax:978-531-7690
Practice Address - Street 1:27 CENTENNIAL DR
Practice Address - Street 2:INTERNAL MEDICINE PHYSICIANS OF THE NORTH SHORE
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7901
Practice Address - Country:US
Practice Address - Phone:978-531-7677
Practice Address - Fax:978-531-7690
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA81772207R00000X, 207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3150313Medicaid
MAA20387Medicare ID - Type Unspecified
G11599Medicare UPIN