Provider Demographics
NPI:1770645350
Name:KLEAGER, LOUIS E (MD)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:E
Last Name:KLEAGER
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 1:212 CARLANNA LAKE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KETCHIKAN
Mailing Address - State:AK
Mailing Address - Zip Code:99901-5613
Mailing Address - Country:US
Mailing Address - Phone:907-228-7611
Mailing Address - Fax:907-247-3306
Practice Address - Street 1:212 CARLANNA LAKE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:KETCHIKAN
Practice Address - State:AK
Practice Address - Zip Code:99901-5613
Practice Address - Country:US
Practice Address - Phone:907-228-7611
Practice Address - Fax:907-247-3306
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK5251207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE31763OtherBCBSNE PPO
SD6520210Medicaid
NE10025334000Medicaid
NE31763OtherBCBS NON PPO #
AK5251OtherMEDICAL LICENSE #
NE91174982300Medicaid
NE91174982301Medicaid
AKMD5055Medicaid
NE13222OtherSTATE MEDICAL LICENSE #
NE8556OtherMIDLANDS CHOICE GROUP
NE8556OtherMIDLANDS CHOICE GROUP
AKMD5055Medicaid
NE10025334000Medicaid
NE31763OtherBCBS NON PPO #