Provider Demographics
NPI:1710977293
Name:KLEMAN, TIMOTHY D (DO)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:KLEMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 188
Mailing Address - Street 2:
Mailing Address - City:MARANA
Mailing Address - State:AZ
Mailing Address - Zip Code:85653-0188
Mailing Address - Country:US
Mailing Address - Phone:520-682-4111
Mailing Address - Fax:520-818-3630
Practice Address - Street 1:16701 N ORACLE RD
Practice Address - Street 2:STE 135
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85739-9102
Practice Address - Country:US
Practice Address - Phone:520-825-6763
Practice Address - Fax:520-825-6841
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4445207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ599128Medicaid
AZ599128Medicaid
AZZ155982Medicare PIN
AZ599128Medicaid
AZ78511Medicare ID - Type Unspecified