Kim Arlan Klancke, MD

Primary specialty

Cardiovascular Disease PhysicianTaxonomy code 207RC0000X

License

ME0039807 Issued in FL

Practice address

655 N Clyde Morris Blvd
Daytona Beach, FL 32114-2321

Phone

(386) 258-8722

Fax

(386) 258-8659

NPI assigned

Mar 27, 2006

Last updated

Dec 7, 2017By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1143417600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1512604800000",
    "number": "1225098981",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "695 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "32114",
            "telephone_number": "386-258-8722",
            "fax_number": "386-258-8659"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "655 N CLYDE MORRIS BLVD",
            "city": "DAYTONA BEACH",
            "state": "FL",
            "postal_code": "321142321",
            "telephone_number": "386-258-8722",
            "fax_number": "386-258-8659"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KLANCKE",
        "first_name": "KIM",
        "middle_name": "ARLAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-03-27",
        "last_updated": "2017-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "FL",
            "license": "ME0039807",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "068030300",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BC BS",
            "identifier": "64479",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Susan Kinsey, PA-C
• Denise Kirkpatrick, CNA
• Annamarie Kisgeropoulos, PA-C
• Chaz Kisgeropoulos
• Kist Alf, Inc
• Glendalyn Elen Klein, M.D.,B.S.N.,R.N.
• James A Klein, M.D.
• Scott David Klioze, M.D.
• Patricia Crouch Klipfel, PT
• David K Klokow, DDS, PA

• Cardiovascular Disease Physician in Daytona Beach, FL
• Providers in Daytona Beach, FL by specialty
• Cardiovascular Disease Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.