Provider Demographics
NPI:1952550527
Name:DR. KLEMPKA FAMILY PRACTICE
Entity Type:Organization
Organization Name:DR. KLEMPKA FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MALGORLATA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLEMPKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:773-725-0800
Mailing Address - Street 1:5931 W LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60630
Mailing Address - Country:US
Mailing Address - Phone:773-725-0800
Mailing Address - Fax:773-725-0808
Practice Address - Street 1:5931 W LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60630
Practice Address - Country:US
Practice Address - Phone:773-725-0800
Practice Address - Fax:773-725-0808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190254861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty