Provider Demographics
NPI:1750466405
Name:KLEE, KARIN L (MD)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:L
Last Name:KLEE
Suffix:
Gender:F
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:PO BOX 4014
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83001-4014
Mailing Address - Country:US
Mailing Address - Phone:307-734-0242
Mailing Address - Fax:307-734-2610
Practice Address - Street 1:555 E. BROADWAY
Practice Address - Street 2:SUITE 216
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001
Practice Address - Country:US
Practice Address - Phone:307-734-0242
Practice Address - Fax:307-734-2610
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY7357A208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO24176079Medicaid
CO24176079Medicaid