Provider Demographics
NPI:1144326737
Name:KLOTT, VIDA HB (MPAS, PAC)
Entity type:Individual
Prefix:MRS
First Name:VIDA
Middle Name:HB
Last Name:KLOTT
Suffix:
Gender:F
Credentials:MPAS, PAC
Other - Prefix:
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Mailing Address - Street 1:6465 MILLENNIUM STE 100
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48917-7831
Mailing Address - Country:US
Mailing Address - Phone:517-975-3720
Mailing Address - Fax:517-323-7633
Practice Address - Street 1:6465 MILLENNIUM STE 100
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48917-7831
Practice Address - Country:US
Practice Address - Phone:517-975-3720
Practice Address - Fax:517-323-7633
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5601004563363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIN77190003OtherMEDICARE PIN
MI0N77190OtherGROUP MEDICARE PIN
MI0N77190OtherGROUP MEDICARE PIN