Basic Information
| Provider Information | |||||||||
| NPI: | 1497763809 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | KLEE | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | K | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 MEDICAL CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496847823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319358000 | ||||||||
| FaxNumber: | 2319358099 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 MEDICAL CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496847823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2319358000 | ||||||||
| FaxNumber: | 2319358099 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/03/2006 | ||||||||
| LastUpdateDate: | 12/21/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 12/21/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 42760 | WI | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 4301070032 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0B81290 | 01 | MI | BCBSM GROUP NUMBER | OTHER | 21014 | 01 | MI | PRIORITY HEALTH GROUP | OTHER | BK6447735 | 01 | WI | DEA | OTHER | 34041500 | 05 | WI | MEDICAID | 4301070032 | 01 | MI | STATE LICENSE | OTHER | B86016127 | 01 | MI | MEDICARE IND PTAN | OTHER | 42760 | 01 | WI | STATE LICENSE | OTHER |