Provider Demographics
NPI:1871568188
Name:WILLIAM J. KLONTZ M.D. INC.
Entity type:Organization
Organization Name:WILLIAM J. KLONTZ M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLONTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-781-7337
Mailing Address - Street 1:4119 WOODCREST CT
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64804-4567
Mailing Address - Country:US
Mailing Address - Phone:417-781-7337
Mailing Address - Fax:417-781-9093
Practice Address - Street 1:1905 W 32ND ST
Practice Address - Street 2:STE 208
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-1529
Practice Address - Country:US
Practice Address - Phone:417-781-7337
Practice Address - Fax:417-781-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2007-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR4D322084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO260013209OtherRAILROAD MEDICARE
MO201882701Medicaid
MO201882701Medicaid
MO000000093Medicare ID - Type UnspecifiedMEDICARE
MOA11850Medicare UPIN