Healthcare Provider Details

I. General information

NPI: 1871596999
Provider Name (Legal Business Name): CHRISTOPHER J KLUGEWICZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2005
Last Update Date: 04/13/2023
Certification Date: 04/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL CENTER BLVD
COOKEVILLE TN
38501-4294
US

IV. Provider business mailing address

127 N OAK AVE STE D
COOKEVILLE TN
38501-2435
US

V. Phone/Fax

Practice location:
  • Phone: 931-783-2770
  • Fax: 931-525-1176
Mailing address:
  • Phone: 931-783-5582
  • Fax: 931-526-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number42656
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number42656
License Number StateTN
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number42656
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: