Provider Demographics
NPI:1205187002
Name:MARK KLIER, MD
Entity type:Organization
Organization Name:MARK KLIER, MD
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:KLIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:585-594-9254
Mailing Address - Street 1:4415 BUFFALO ROAD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:N. CHILI
Mailing Address - State:NY
Mailing Address - Zip Code:14514
Mailing Address - Country:US
Mailing Address - Phone:585-594-9254
Mailing Address - Fax:595-594-9233
Practice Address - Street 1:4415 BUFFALO ROAD
Practice Address - Street 2:SUITE 1B
Practice Address - City:N. CHILI
Practice Address - State:NY
Practice Address - Zip Code:14514
Practice Address - Country:US
Practice Address - Phone:585-594-9254
Practice Address - Fax:595-594-9233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-20
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY173484208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty