Individual
DANIEL WAYNE KLETZING
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6301 UNIVERSITY COMMONS, SUITE 360, SOUTH BEND, IN 46635-1571
(574) 232-4800
(574) 280-4810
Mailing address
6301 UNIVERSITY COMMONS, 360, SOUTH BEND, IN 46635-1571
(574) 232-4800
(574) 280-4810
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
Primary
01023918
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000085512
ANTHEM BCBS PIN
IN
01
—
01023918
LICENSE NUMBER
IN
05
—
100143280A
—
IN
Enumeration date
05/09/2006
Last updated
03/07/2023
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