Provider Demographics
NPI:1861437782
Name:KLENZ, MARY ELIZABETH (MD)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:ELIZABETH
Last Name:KLENZ
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:M.
Other - Middle Name:ELIZABETH
Other - Last Name:KLENZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1400 E RIDGE RD STE #4
Mailing Address - Street 2:
Mailing Address - City:MCALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:78503
Mailing Address - Country:US
Mailing Address - Phone:956-630-0240
Mailing Address - Fax:956-630-1470
Practice Address - Street 1:1400 E RIDGE RD STE #4
Practice Address - Street 2:
Practice Address - City:MCALLEN
Practice Address - State:TX
Practice Address - Zip Code:78503
Practice Address - Country:US
Practice Address - Phone:956-630-0240
Practice Address - Fax:956-630-1470
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8264207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX037567702Medicaid
TX612506Medicare PIN
TX037567702Medicaid