MEDICARE: DR. MICHAEL SCOTT KLUSKA DO

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	208200000X	Plastic Surgery Physician	OS010619L	PA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	82763	GA
3	208200000X	Plastic Surgery Physician	82763	GA

General Provider Information

NPI Number	:	1184621757
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SCOTT KLUSKA DO

Provider Business Mailing Address
First Line	:	30931 HIGHWAY 441 S
Second Line	:
City	:	COMMERCE
State	:	GA
Zip	:	30529
Country	:	US
Telephone Number	:	706-335-3555
Fax Number	:	706-336-8122

Provider Business Practice Location Address
First Line	:	30931 HIGHWAY 441 S
Second Line	:
City	:	COMMERCE
State	:	GA
Zip	:	30529
Country	:	US
Telephone Number	:	706-335-3555
Fax Number	:	706-336-8122

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	05/21/2024

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