Provider Demographics
NPI:1679957328
Name:KLOECK, ALEXANDRA SHENDRIK (DPM)
Entity type:Individual
Prefix:DR
First Name:ALEXANDRA
Middle Name:SHENDRIK
Last Name:KLOECK
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:ALEXANDRA
Other - Middle Name:
Other - Last Name:SHENDRIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:1501 N FLORENCE AVE STE 350
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74017-3275
Mailing Address - Country:US
Mailing Address - Phone:918-343-8574
Mailing Address - Fax:918-343-8575
Practice Address - Street 1:1501 N FLORENCE AVE STE 350
Practice Address - Street 2:
Practice Address - City:CLAREMORE
Practice Address - State:OK
Practice Address - Zip Code:74017-3275
Practice Address - Country:US
Practice Address - Phone:918-343-8574
Practice Address - Fax:918-343-8575
Is Sole Proprietor?:No
Enumeration Date:2015-07-13
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK335213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery