MEDICARE: DENVER OCCUPATIONAL & AVIATION MED. CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	16150	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	KW63304	OTHER	CO	BLUESHIELD

General Provider Information

NPI Number	:	1003800558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENVER OCCUPATIONAL & AVIATION MED. CLINIC

Provider Business Mailing Address
First Line	:	3464 S WILLOW ST
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80231-4531
Country	:	US
Telephone Number	:	303-755-2900
Fax Number	:	303-755-0404

Provider Business Practice Location Address
First Line	:	3700 HAVANA ST
Second Line	:	SUITE 200
City	:	DENVER
State	:	CO
Zip	:	80239-3240
Country	:	US
Telephone Number	:	303-373-4456
Fax Number	:	303-373-4501

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CLARENCE J. KLUCK
Credential	:	M.D.
Telephone Number	:	303-373-4456

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	08/22/2020

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