Active NPI
Paul J Klazura, M.D.
- Vascular Surgery Physician
- Rockford, IL
National Provider Identifier
1407852551
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Vascular Surgery Physician
- License
- 036063647
- Practice address
- 2300 N Rockton Ave
Ste 304
Rockford, IL 61103-3619 - Phone
- (815) 864-3333
- Fax
- (815) 964-3331
- NPI assigned
- Jun 23, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Surgery Physician | 208600000X | 036063647 | IL | |
| Trauma Surgery Physician | 2086S0127X | 036063647 | IL | |
| Vascular Surgery Physician | 2086S0129X | 036063647 | IL | Primary |
Addresses
Primary practice location
2300 N Rockton Ave
Ste 304
Rockford, IL 61103-3619
Mailing address
PO Box 15730
Loves Park, IL 61132-5730
Phone (815) 964-3333
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 204575400 | Other | IL | OWCP |
| 036063547 2 | Medicaid | IL | |
| 194343 | Other | IL | PERSONAL CARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 036063647 | IL | MD | Trauma Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1119484800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358899200000",
"number": "1407852551",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 15730",
"city": "LOVES PARK",
"state": "IL",
"postal_code": "611325730",
"telephone_number": "815-964-3333",
"fax_number": "815-964-3331"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2300 N ROCKTON AVE",
"address_2": "STE 304",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611033619",
"telephone_number": "815-864-3333",
"fax_number": "815-964-3331"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KLAZURA",
"first_name": "PAUL",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-06-23",
"last_updated": "2013-01-23",
"status": "A"
},
"taxonomies": [
{
"code": "208600000X",
"taxonomy_group": "",
"desc": "Surgery",
"state": "IL",
"license": "036063647",
"primary": false
},
{
"code": "2086S0127X",
"taxonomy_group": "",
"desc": "Surgery, Trauma Surgery",
"state": "IL",
"license": "036063647",
"primary": false
},
{
"code": "2086S0129X",
"taxonomy_group": "",
"desc": "Surgery, Vascular Surgery",
"state": "IL",
"license": "036063647",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OWCP",
"identifier": "204575400",
"state": "IL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "036063547 2",
"state": "IL"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PERSONAL CARE",
"identifier": "194343",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Rockford, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.