Provider Demographics
NPI:1881815629
Name:KLIMEK, DAVID E (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:E
Last Name:KLIMEK
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 FULLER CT
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48105-2311
Mailing Address - Country:US
Mailing Address - Phone:734-995-0999
Mailing Address - Fax:
Practice Address - Street 1:2200 FULLER CT
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48105-2311
Practice Address - Country:US
Practice Address - Phone:734-995-0999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2014-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301002261103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI68OH14967OtherCLINICAL PSYCHOLOGIST
MI0M10560Medicare ID - Type UnspecifiedPSYCHOLOGIST