Healthcare Provider Details

I. General information

NPI: 1487638177
Provider Name (Legal Business Name): PAUL KLUGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 12/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

885 UNION ST SUITE 145
BANGOR ME
04401-3083
US

IV. Provider business mailing address

43 WHITING HILL RD
BREWER ME
04412-1005
US

V. Phone/Fax

Practice location:
  • Phone: 207-973-9595
  • Fax: 207-973-7898
Mailing address:
  • Phone: 207-973-5000
  • Fax: 207-973-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number012600
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: