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1871596999

NPI Code Detail

MEDICARE: DR. CHRISTOPHER J KLUGEWICZ M.D.

MEDICARE: DR. CHRISTOPHER J KLUGEWICZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	42656	TN
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	42656	TN
3	208M00000X	Hospitalist Physician	42656	TN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
5	3000888	OTHER	TN	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	260245416	OTHER	TN	GEHA
2	284997	OTHER	FL	AVMED
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	17123	OTHER	FL	BCBS
7	7948383	OTHER	FL	AETNA
8	4162482	OTHER	TN	BCBS
9	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871596999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER J KLUGEWICZ M.D.

Provider Business Mailing Address
First Line	:	127 N OAK AVE STE D
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-2435
Country	:	US
Telephone Number	:	931-783-5582
Fax Number	:	931-526-6760

Provider Business Practice Location Address
First Line	:	1 MEDICAL CENTER BLVD
Second Line	:
City	:	COOKEVILLE
State	:	TN
Zip	:	38501-4294
Country	:	US
Telephone Number	:	931-783-2770
Fax Number	:	931-525-1176

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/13/2023

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Directions to “ DR. CHRISTOPHER J KLUGEWICZ M.D.” Practice Location

Language	Start Address	Practice Location

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