Individual
DR. MICHAEL L KLYACHKIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
688 WALNUT ST, STE 200, MACON, GA 31201-2677
(478) 742-7566
(478) 743-2804
Mailing address
688 WALNUT ST, STE 200, MACON, GA 31201-2677
(478) 742-7566
(478) 743-2804
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
54760
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
511I770014
MEDICARE
—
05
—
519931565A
—
GA
Enumeration date
01/16/2006
Last updated
08/22/2008
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