Healthcare Provider Details

I. General information

NPI: 1043147002
Provider Name (Legal Business Name): WOJCIECH STEFAN KLUZEK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2026
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 MOONEY ST
WINSTON SALEM NC
27103-3027
US

IV. Provider business mailing address

MEDICAL CENTER BOULEVARD DEPARTMENT OF ORTHOPAEDIC SURGERY AND REHABILITATION
WINSTON SALEM NC
27157-0001
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-8091
  • Fax:
Mailing address:
  • Phone: 336-716-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number2025-03097
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: