Individual
JUSTIN L KLANKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20 MEDICAL VILLAGE DR, SUITE 258, EDGEWOOD, KY 41017-5401
(859) 341-7246
(859) 341-7867
Mailing address
20 MEDICAL VILLAGE DR STE 258, EDGEWOOD, KY 41017-5411
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
53055
MN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
611077369004
HEALTHNET
KY
05
—
7100254430
—
KY
Enumeration date
08/13/2009
Last updated
06/17/2015
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