Provider Demographics
NPI:1366979080
Name:KLIGERMAN, MAXWELL (MD, MPH)
Entity type:Individual
Prefix:
First Name:MAXWELL
Middle Name:
Last Name:KLIGERMAN
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:EMORY SCHOOL OF MEDICINE DEPARTMENT OF OTOLARYNGOLOGY
Mailing Address - Street 2:2675 N DECATUR ROADE, SUITE 707
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033
Mailing Address - Country:US
Mailing Address - Phone:404-778-3381
Mailing Address - Fax:
Practice Address - Street 1:EMORY UNIVERSITY SCHOOL OF MEDICINE
Practice Address - Street 2:2675 N DECATUR ROAD, SUITE 707
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033
Practice Address - Country:US
Practice Address - Phone:404-778-3381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
GA95753207YX0007X
CAA158560207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology