Provider Demographics
NPI:1336231257
Name:KLIMKOWSKI, WALTER JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:JOHN
Last Name:KLIMKOWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21250 HALL RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48038-7232
Mailing Address - Country:US
Mailing Address - Phone:586-465-2000
Mailing Address - Fax:586-465-2002
Practice Address - Street 1:21250 HALL RD
Practice Address - Street 2:SUITE 200
Practice Address - City:CLINTON TOWNSHIP
Practice Address - State:MI
Practice Address - Zip Code:48038-7232
Practice Address - Country:US
Practice Address - Phone:586-465-2000
Practice Address - Fax:586-465-2002
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080710207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4994748Medicaid
MI7230797OtherAETNA
MI700E020100OtherBCBS GROUP NUMBER
MI7230797OtherAETNA
MII47431Medicare UPIN
MIP44640001Medicare PIN