Provider Demographics
NPI:1851365530
Name:KLOSS, RAYMOND (MD)
Entity Type:Individual
Prefix:
First Name:RAYMOND
Middle Name:
Last Name:KLOSS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:N17W24100 RIVERWOOD DR
Mailing Address - Street 2:WAUKESHA HEALTH CARE INC
Mailing Address - City:WAUKESHA
Mailing Address - State:WI
Mailing Address - Zip Code:53188-1177
Mailing Address - Country:US
Mailing Address - Phone:262-928-4100
Mailing Address - Fax:262-928-5835
Practice Address - Street 1:721 AMERICAN AVE
Practice Address - Street 2:BEHAVIORAL MEDICINE CENTER, SUITE 501
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5071
Practice Address - Country:US
Practice Address - Phone:262-928-2396
Practice Address - Fax:262-544-1213
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-17
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI335192084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31838900Medicaid
WIF34925Medicare UPIN
WI31838900Medicaid