Provider Demographics
NPI:1205880937
Name:KLEMP, JANICE (MD)
Entity type:Individual
Prefix:DR
First Name:JANICE
Middle Name:
Last Name:KLEMP
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 1:500 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1569
Mailing Address - Country:US
Mailing Address - Phone:906-483-1700
Mailing Address - Fax:906-483-1122
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1569
Practice Address - Country:US
Practice Address - Phone:906-483-1700
Practice Address - Fax:906-483-1122
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI43043899208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0829560001OtherMEDICARE DME
MI0C16002OtherMEDICARE GROUP
MI104361996Medicaid
MIJK043899OtherBLUECROSS STATE ID
MI0829560001OtherMEDICARE DME
MI104361996Medicaid