| Doctor Name: | MICHAEL KLOSE |
| NPI Number: | 1053717975 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 2501 Capehart Rd Offutt Afb, NE - 681131043 |
| Business Phone Number: | 4022328046 |
| Business Fax Number: | |
| Mailing Address: | 1381 S Patrick Dr, PATRICK AFB |
| State: | FL |
| Postal Code: | 329253606 |
| Phone Number: | 3214941148 |
| Fax Number: | |
| NPI Enumeration Date: | 11/05/2014 |
| NPI Last Update Date: | 11/02/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |