Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207KA0200X | Allergist | OS 0006759 | FL |
NPI | 1043490055 |
---|---|
Provider Name | Dr. Charles V. Klucka |
First Address | Fort Myers, FL 33908-7606 |
Second Address | Fort Myers, FL 33908-7606 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/11/2007 |
Last Update Date | 12/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F87731 | (02) | FL |