Provider Demographics
NPI:1710955414
Name:KLOMPAS, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KLOMPAS
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 1:15 FRANCIS ST
Mailing Address - Street 2:PBB-4
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6105
Mailing Address - Country:US
Mailing Address - Phone:617-732-8881
Mailing Address - Fax:
Practice Address - Street 1:15 FRANCIS ST
Practice Address - Street 2:PBB-4
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6105
Practice Address - Country:US
Practice Address - Phone:617-732-8881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2012-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA213643207R00000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine