Provider Demographics
NPI:1013904788
Name:KLOCEK, JAMES JOSEPH (DPM)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:JOSEPH
Last Name:KLOCEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 MILFORD ST
Mailing Address - Street 2:SUITE 504-A
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6953
Mailing Address - Country:US
Mailing Address - Phone:410-546-2288
Mailing Address - Fax:410-546-2339
Practice Address - Street 1:106 MILFORD ST
Practice Address - Street 2:SUITE 504-A
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6953
Practice Address - Country:US
Practice Address - Phone:410-546-2288
Practice Address - Fax:410-546-2339
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-28
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01199213E00000X, 213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDKCV6OtherBC/BS
MD1447442462OtherNPI
MD328420OtherMAMSI
MDU19341Medicare UPIN
MDKCV6OtherBC/BS