Individual
DR. KENNETH D. KLEIST
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1970 S RIDGE RD, GREEN BAY, WI 54304-4125
(920) 430-4888
(920) 430-4889
Mailing address
PO BOX 22487, GREEN BAY, WI 54305-2487
(920) 445-7222
(920) 445-7289
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
54913-20
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
450030707
MEDICARE PTAN
WI
01
—
711290105
MEDICARE PTAN
WI
Enumeration date
01/13/2006
Last updated
12/07/2018
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