Provider Demographics
NPI:1396899431
Name:KLING, GREGG A (DO)
Entity type:Individual
Prefix:
First Name:GREGG
Middle Name:A
Last Name:KLING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2807 BRITTANY CT
Mailing Address - Street 2:
Mailing Address - City:ST CHARLES
Mailing Address - State:IL
Mailing Address - Zip Code:60175-5161
Mailing Address - Country:US
Mailing Address - Phone:630-377-8944
Mailing Address - Fax:
Practice Address - Street 1:ONE KISH HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-4939
Practice Address - Country:US
Practice Address - Phone:815-756-1521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL064886OtherHEALTH ALLIANCE
ILP00295214Medicare PIN
IL064886OtherHEALTH ALLIANCE
ILK11483Medicare PIN
ILL19868Medicare PIN