Provider Demographics
NPI:1841282068
Name:KLAUK, LEE ARTHUR (DPM)
Entity type:Individual
Prefix:DR
First Name:LEE
Middle Name:ARTHUR
Last Name:KLAUK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54911-4637
Mailing Address - Country:US
Mailing Address - Phone:920-733-5345
Mailing Address - Fax:920-733-1390
Practice Address - Street 1:209 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54911-4637
Practice Address - Country:US
Practice Address - Phone:920-733-5345
Practice Address - Fax:920-733-1390
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI341-025213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43210500Medicaid
WI43210500Medicaid