Healthcare Provider Details

I. General information

NPI: 1750390613
Provider Name (Legal Business Name): GEORGE KLUTINOTY II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1650 COCHRANE CIRCLE EVANS ARMY COMMUNITY HOSPITAL (EACH) USA MEDDAC
FT. CARSON CO
80913-4604
US

IV. Provider business mailing address

1650 COCHRANE CIRCLE EVANS ARMY COMMUNITY HOSPITAL (EACH) USA MEDDAC
FORT CARSON CO
80913-4604
US

V. Phone/Fax

Practice location:
  • Phone: 719-524-4068
  • Fax: 719-524-7404
Mailing address:
  • Phone: 719-526-7844
  • Fax: 719-526-7984

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01020131A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: