Provider Demographics
NPI:1881674125
Name:KLIMOW, SUSAN S (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:S
Last Name:KLIMOW
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 202113
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99520-2113
Mailing Address - Country:US
Mailing Address - Phone:907-929-8704
Mailing Address - Fax:907-929-8744
Practice Address - Street 1:4100 LAKE OTIS PKWY
Practice Address - Street 2:SUITE 216
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-5222
Practice Address - Country:US
Practice Address - Phone:907-563-2873
Practice Address - Fax:907-563-5852
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK31352081P2900X, 208VP0000X
171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Not Answered208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
Not Answered171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKMD3135Medicaid
AKF56100Medicare UPIN
AK160276Medicare ID - Type UnspecifiedNORIDIAN MEDICARE