Provider Demographics
NPI:1871534644
Name:KLARA, PETER MICHAEL (MD, PHD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:MICHAEL
Last Name:KLARA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 N NEVADA AVE STE 5001
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-6865
Mailing Address - Country:US
Mailing Address - Phone:719-776-3580
Mailing Address - Fax:719-776-3599
Practice Address - Street 1:2222 N NEVADA AVE STE 5001
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-6865
Practice Address - Country:US
Practice Address - Phone:719-776-3580
Practice Address - Fax:719-776-3599
Is Sole Proprietor?:No
Enumeration Date:2006-06-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD00000239247207T00000X
IL036-087965207T00000X
CODR.0052963207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA39865OtherIOWA BOARD OF MEDICINE
TN4155807OtherBLUE CROSS HMA
TN4155807OtherBLUE CROSS HMA
TN4155807OtherBLUE CROSS HMA
BK3941879OtherDEA
B08027Medicare UPIN