Healthcare Provider Details

I. General information

NPI: 1578719365
Provider Name (Legal Business Name): JOSHUA T KLUETZ DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2008
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7930 N SHADELAND AVE STE 200
INDIANAPOLIS IN
46250-2943
US

IV. Provider business mailing address

6626 E 75TH ST SUITE 500
INDIANAPOLIS IN
46250-2805
US

V. Phone/Fax

Practice location:
  • Phone: 317-497-6024
  • Fax: 317-497-2507
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number02004210A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: