Individual
KURT J KLISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
250 SW BROOKSIDE DR, GRIMES, IA 50111-4900
(515) 300-3900
(515) 300-3901
Mailing address
PO BOX 1475, DES MOINES, IA 50305-1475
(515) 300-3900
(515) 300-3901
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
24439
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080195357
RR MEDICARE
IA
05
—
3219469
—
IA
Enumeration date
09/26/2005
Last updated
03/17/2018
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