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NPI Code Detail

MEDICARE: RICHARD P KLUCZNIK M.D.

MEDICARE: RICHARD P KLUCZNIK M.D.
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
12085R0202XDiagnostic Radiology PhysicianJ2643TX
22085N0700XNeuroradiology PhysicianME157552FL

Other Identifiers

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

General Provider Information

NPI Number : 1235129958
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD P KLUCZNIK M.D.
Provider Business Mailing Address
First Line : DEPT 488
Second Line : PO BOX 4346
City : HOUSTON
State : TX
Zip : 77210-4346
Country : US
Telephone Number : 713-441-7558
Fax Number : 713-790-2948
Provider Business Practice Location Address
First Line : 3100 E FLETCHER AVE
Second Line :
City : TAMPA
State : FL
Zip : 33613-4613
Country : US
Telephone Number : 813-615-7075
Fax Number : 813-615-8086
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2005
Last Update Date : 04/04/2023

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