Provider Demographics
NPI:1982812236
Name:KLENCZAR, MELISSA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANNE
Last Name:KLENCZAR
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:ANNE
Other - Last Name:KIMBALL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3226 HIDDEN TIMBER DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LAKE ORION
Mailing Address - State:MI
Mailing Address - Zip Code:48359-1598
Mailing Address - Country:US
Mailing Address - Phone:248-391-1780
Mailing Address - Fax:248-391-1862
Practice Address - Street 1:3226 HIDDEN TIMBER DR
Practice Address - Street 2:SUITE A
Practice Address - City:LAKE ORION
Practice Address - State:MI
Practice Address - Zip Code:48359-1598
Practice Address - Country:US
Practice Address - Phone:248-391-1780
Practice Address - Fax:248-391-1862
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301083991207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine