Individual
MANDY A KLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
601 US 224, SUITE 2, GLANDORF, OH 45848-0081
(419) 538-7330
(419) 538-7331
Mailing address
PO BOX 636930, CINCINNATI, OH 45263-0001
(419) 538-7330
(419) 538-7331
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
083647
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2986729
—
OH
01
—
9364531
GROUP MEDICARE PIN
OH
Enumeration date
06/23/2005
Last updated
04/18/2014
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