Individual
KENNETH DONALD KLOS JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
7595 TIMBERLORE TRL, COOK, MN 55723-8728
(218) 290-4381
Mailing address
7595 TIMBERLORE TRL, COOK, MN 55723-8728
(218) 290-4381
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
R076202-1
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
891043000
—
MN
Enumeration date
08/11/2005
Last updated
09/29/2011
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