Individual
MR. JACK H KLIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 RANDALL SQ, SUITE 305, PROVIDENCE, RI 02904-2709
(401) 521-0700
(401) 521-0906
Mailing address
1 RANDALL SQ, SUITE 305, PROVIDENCE, RI 02904-2709
(401) 521-0700
(401) 521-0906
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4568
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001218
BLUE CHIP
RI
01
—
849
BLUE CROSS
RI
05
—
9000849
—
RI
Enumeration date
11/13/2006
Last updated
03/13/2009
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