Organization
MICHEAL J KLITZKE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL JOHN KLITZKE PHD (PRESIDENT/OWNER)
(865) 588-6916
Entity
Organization
Contact information
Practice address
6025 BROOKVALE LN, SUITE 205, KNOXVILLE, TN 37919-4031
(865) 588-6916
Mailing address
6025 BROOKVALE LN, SUITE 205, KNOXVILLE, TN 37919-4031
(865) 588-6916
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
Primary
1761
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3688001
—
TN
Enumeration date
04/17/2008
Last updated
04/17/2008
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