Provider Demographics
NPI:1902883234
Name:KLIR, WESLEY A (MD)
Entity Type:Individual
Prefix:
First Name:WESLEY
Middle Name:A
Last Name:KLIR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:109 S BROAD ST
Mailing Address - City:KALIDA
Mailing Address - State:OH
Mailing Address - Zip Code:45853-0417
Mailing Address - Country:US
Mailing Address - Phone:419-532-3958
Mailing Address - Fax:419-532-2326
Practice Address - Street 1:109 S BROAD ST
Practice Address - Street 2:
Practice Address - City:KALIDA
Practice Address - State:OH
Practice Address - Zip Code:45853
Practice Address - Country:US
Practice Address - Phone:419-532-3958
Practice Address - Fax:419-532-2326
Is Sole Proprietor?:No
Enumeration Date:2005-12-28
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35075209K207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2196752Medicaid
000000185580OtherANTHEM
CH3755OtherRAILROAD MEDICARE
CH3755OtherRAILROAD MEDICARE
OH2196752Medicaid