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General NPI Number Information
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NPI Number | 1407846496
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Entity Type | Individual
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Provider Name | JOHN COOKE KLUZNIK MD
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Gender | Male
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Dates
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Enumeration Date | 10/21/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2960 WINNETKA AVE N SUITE 208
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City | CRYSTAL
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State | MN
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Zip | 55427-2853
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Country | US
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Telephone | 763-512-1090
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Fax |
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Provider Business Mailing Address
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Address Line | 1042 SUMMIT AVE
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City | SAINT PAUL
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State | MN
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Zip | 55105-3003
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Country | US
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Telephone | 651-293-1076
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 21665
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License Number State | MN
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