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NPI Code Detail

MEDICARE: DONNA K MCCLUSKEY DO

MEDICARE:   DONNA K MCCLUSKEY  DO
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
1207Q00000XFamily Medicine Physician2743SD
2207Q00000XFamily Medicine Physician48303MN
3207Q00000XFamily Medicine PhysicianR9F27MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902885452
Entity Type Code : Individual
Provider Name (Legal Business Name) : DONNA K MCCLUSKEY DO
Provider Business Mailing Address
First Line : 3308 W EDGEWOOD DR
Second Line : SUITE B
City : JEFFERSON CITY
State : MO
Zip : 65109-6891
Country : US
Telephone Number : 573-893-7848
Fax Number : 573-893-1984
Provider Business Practice Location Address
First Line : 3308 W EDGEWOOD DR
Second Line : SUITE B
City : JEFFERSON CITY
State : MO
Zip : 65109-6891
Country : US
Telephone Number : 573-893-7848
Fax Number : 573-893-1984
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2006
Last Update Date : 02/11/2016

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Directions to “ DONNA K MCCLUSKEY DO” Practice Location

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