Individual
DR. PAUL J KLAZURA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2300 N ROCKTON AVE, STE 304, ROCKFORD, IL 61103-3619
(815) 864-3333
(815) 964-3331
Mailing address
PO BOX 15730, LOVES PARK, IL 61132-5730
(815) 964-3333
(815) 964-3331
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
036063647
IL
2086S0127X
Trauma Surgery Physician
036063647
IL
2086S0129X
Vascular Surgery Physician
Primary
036063647
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036063547 2
—
IL
01
—
194343
PERSONAL CARE
IL
01
—
204575400
OWCP
IL
Enumeration date
06/23/2005
Last updated
01/23/2013
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