Provider Demographics
NPI:1689672131
Name:KLAUSING, BRIAN JAMES (PA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:JAMES
Last Name:KLAUSING
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 MEDICAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-4099
Mailing Address - Country:US
Mailing Address - Phone:419-222-6622
Mailing Address - Fax:419-224-0015
Practice Address - Street 1:801 MEDICAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:LIMA
Practice Address - State:OH
Practice Address - Zip Code:45804-4099
Practice Address - Country:US
Practice Address - Phone:419-222-6622
Practice Address - Fax:419-224-0015
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.001289363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000496668OtherANTHEM
OHPA12581Medicare PIN
OHS65876Medicare UPIN