Provider Demographics
NPI:1841208782
Name:KLIMOVA, IRINA VIKTOROVNA (MD)
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:VIKTOROVNA
Last Name:KLIMOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:IRINA
Other - Middle Name:VIKTOROVNA
Other - Last Name:KVATADZE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 131158
Mailing Address - Street 2:ANN ARBOR INPT PHYSICIANS
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48113-1158
Mailing Address - Country:US
Mailing Address - Phone:734-737-0970
Mailing Address - Fax:734-737-0974
Practice Address - Street 1:5301 E HURON RIVER DR
Practice Address - Street 2:ST JOSEPH MERCY HOSPITAL
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197
Practice Address - Country:US
Practice Address - Phone:734-712-3456
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301079903207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine