Provider Demographics
NPI:1124074208
Name:KLIGER, GRIGORY (MD)
Entity type:Individual
Prefix:DR
First Name:GRIGORY
Middle Name:
Last Name:KLIGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17150 COLLINS AVE
Mailing Address - Street 2:SUITE 101-315
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-3688
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5595 ORANGE DR
Practice Address - Street 2:SUITE 206
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33314-3825
Practice Address - Country:US
Practice Address - Phone:954-583-5099
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 82106207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265599300Medicaid
FL62740Medicare ID - Type UnspecifiedPROVIDER #
FL265599300Medicaid