Provider Demographics
NPI:1245345727
Name:GLEESON, ROBERT KLINGER (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:KLINGER
Last Name:GLEESON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:840 N 87TH ST
Mailing Address - Street 2:SARGEANT HEALTH CENTER
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53226-3586
Mailing Address - Country:US
Mailing Address - Phone:414-805-5540
Mailing Address - Fax:414-805-7878
Practice Address - Street 1:840 N 87TH ST
Practice Address - Street 2:SARGEANT HEALTH CENTER
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53226-3586
Practice Address - Country:US
Practice Address - Phone:414-805-5540
Practice Address - Fax:414-805-7878
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2012-08-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WI24313 - 020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1245345727Medicaid
WI1245345727Medicaid