Provider Demographics
NPI:1487623435
Name:KLENOW, CHERYL MARIE (MD)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:MARIE
Last Name:KLENOW
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1835 WEST COUNTY ROAD C
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1304
Mailing Address - Country:US
Mailing Address - Phone:763-785-4500
Mailing Address - Fax:763-785-7779
Practice Address - Street 1:1835 WEST COUNTY ROAD C
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1304
Practice Address - Country:US
Practice Address - Phone:763-785-4500
Practice Address - Fax:763-785-7779
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN365912083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN842974000Medicaid
MN842974000Medicaid