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Individual

ANNA KLYACHKINA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
M.D.

Contact information

Practice address
12225 71ST ST, KENOSHA, WI 53142-7320
(262) 948-4870
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250

Taxonomy

Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
036107503
IL
2084P0800X
Psychiatry Physician
Primary
51332
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036107503
IL
05
34999600
WI
Enumeration date
03/31/2006
Last updated
04/17/2024
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