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General NPI Number Information
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NPI Number | 1942682455
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Entity Type | Organization
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Legal Business Name | GK MEDICAL CONSULTING LLC
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Dates
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Enumeration Date | 06/20/2015
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Last Update Date | 07/10/2023
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Provider Practice Location Address
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Address Line | 1010 WOODMAN DR SUITE 220
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City | DAYTON
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State | OH
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Zip | 45432-1400
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Country | US
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Telephone | 937-258-0682
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Fax |
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Provider Business Mailing Address
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Address Line | 1010 WOODMAN DR SUITE 220
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City | DAYTON
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State | OH
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Zip | 45432-1400
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Country | US
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Telephone | 937-258-0682
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GLENN HERMAN KLUGE
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Credential | MD
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Telephone | 937-838-0036
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RA0401X
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Taxonomy Name | Addiction Medicine (Internal Medicine) Physician
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License Number | 35.057549
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License Number State | OH
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