Healthcare Provider Details

I. General information

NPI: 1437342748
Provider Name (Legal Business Name): MATTHEW KLUK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 12/31/2020
Certification Date: 12/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5818 N NEVADA AVENUE SUITE 110
COLORADO SPRINGS CO
80918
US

IV. Provider business mailing address

175 S UNION BLVD STE 310
COLORADO SPRINGS CO
80910-3126
US

V. Phone/Fax

Practice location:
  • Phone: 719-365-1950
  • Fax:
Mailing address:
  • Phone: 719-365-1950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number0101245900
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberDR.0062365
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: