Provider Demographics
NPI:1609836139
Name:KLEMME, KIRK R (MD)
Entity type:Individual
Prefix:DR
First Name:KIRK
Middle Name:R
Last Name:KLEMME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 CAMPUS DR
Mailing Address - Street 2:
Mailing Address - City:HANCOCK
Mailing Address - State:MI
Mailing Address - Zip Code:49930-1569
Mailing Address - Country:US
Mailing Address - Phone:906-483-1000
Mailing Address - Fax:906-483-1122
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1569
Practice Address - Country:US
Practice Address - Phone:906-483-1000
Practice Address - Fax:906-483-1122
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2022-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43038247207L00000X
WI32018-202083A0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083A0300XAllopathic & Osteopathic PhysiciansPreventive MedicineAddiction Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIKK038247OtherBLUECROSS STATE ID
MI0829560001OtherMEDICARE DME
MI0C16002OtherMEDICARE GROUP
MI103315694Medicaid
MI0829560001OtherMEDICARE DME
MI0C16002036Medicare ID - Type Unspecified