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General NPI Number Information
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NPI Number | 1760431175
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Entity Type | Individual
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Provider Name | KARL NICHOLAS KALUZA D.O.
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Gender | Male
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Dates
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Enumeration Date | 05/10/2006
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Last Update Date | 05/21/2019
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Provider Practice Location Address
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Address Line | 4811 MEADOWS RD STE 101
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City | LAKE OSWEGO
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State | OR
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Zip | 97035-2542
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Country | US
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Telephone | 360-254-6161
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Fax | 360-449-1146
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Provider Business Mailing Address
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Address Line | 200 NE MOTHER JOSEPH PL STE 210
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City | VANCOUVER
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State | WA
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Zip | 98664-3295
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Country | US
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Telephone | 360-254-6161
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Fax | 360-449-1146
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | DO23861
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License Number State | OR
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