Provider Demographics
NPI:1821066929
Name:KLEEMAN, KURT MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:MATTHEW
Last Name:KLEEMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KURT
Other - Middle Name:M
Other - Last Name:KLEEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2341 VILLARET DR SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35803-2194
Mailing Address - Country:US
Mailing Address - Phone:256-883-6471
Mailing Address - Fax:
Practice Address - Street 1:2341 VILLARET DR SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35803-2194
Practice Address - Country:US
Practice Address - Phone:256-883-6471
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2013-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051525260OtherBLUE CROSS BLUE SHIELD
E94394Medicare UPIN