Individual
KIM ARLAN KLANCKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
655 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2321
(386) 258-8722
(386) 258-8659
Mailing address
695 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114
(386) 258-8722
(386) 258-8659
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
ME0039807
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
068030300
—
FL
01
—
64479
BC BS
FL
Enumeration date
03/27/2006
Last updated
12/07/2017
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