Individual
DR. BRYAN J. KLICH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6847 N CHESTNUT ST, RAVENNA, OH 44266-3929
(330) 297-2850
Mailing address
PO BOX 661630, ARCADIA, CA 91066-1630
(626) 447-0296
(626) 447-6057
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
35-087357
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000389975
ANTHEM PROVIDER NUMBER
OH
05
—
2642153
—
OH
Enumeration date
08/10/2006
Last updated
05/31/2013
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