Provider Demographics
NPI:1871710004
Name:KLEM, JACK MAREK (MD)
Entity type:Individual
Prefix:DR
First Name:JACK
Middle Name:MAREK
Last Name:KLEM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:8720 N KENDALL DR STE 108
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176-2208
Mailing Address - Country:US
Mailing Address - Phone:786-213-3847
Mailing Address - Fax:305-554-7616
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:
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97440207T00000X
IDM-17074207T00000X
CODR.0069409207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery