Provider Demographics
NPI:1023160207
Name:KLOEHN, ROGER WALTER (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:WALTER
Last Name:KLOEHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7920 N FAIRCHILD ROAD
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-3117
Mailing Address - Country:US
Mailing Address - Phone:414-351-1147
Mailing Address - Fax:
Practice Address - Street 1:7920 N FAIRCHILD ROAD
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53217-3117
Practice Address - Country:US
Practice Address - Phone:414-351-1147
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14531-020207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIB54205Medicare ID - Type Unspecified