Individual
JOSEPH MICHAEL KLICK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
717 S STATE ST, STE 100, FAIRMONT, MN 56031-4470
(507) 235-3939
Mailing address
400 E 10TH ST, WACONIA, MN 55387-4552
(952) 442-9770
(952) 442-3620
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R0799010
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1103036
ARAZ
MN
01
—
143425200
US DEPARTMENT OF LABOR
MN
05
—
177742400
—
MN
01
—
2552
ARAZ
MN
01
—
27G81KL
BLUE CROSS MN
MN
01
—
430056096
PALMETTO GBA RR MC
MN
Enumeration date
05/23/2005
Last updated
04/28/2008
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