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NPI Code Detail

MEDICARE: DR. DAVID D CLUTTS M.D.

MEDICARE: DR. DAVID D CLUTTS 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
1208600000XSurgery Physician36-078587IL

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
520016640OTHERILRR MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1027516OTHERILHEALTH ALLIANCE
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
33932056OTHERILBCBS OF IL
47210895OTHERILAETNA
6142410OTHERILHEALTHLINK INSURANCE
7324130OTHERILGHP
842496OTHERILGHP

General Provider Information

NPI Number : 1407822406
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID D CLUTTS M.D.
Provider Business Mailing Address
First Line : PO BOX 1105
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46206-1105
Country : US
Telephone Number : 618-549-5361
Fax Number : 618-549-5128
Provider Business Practice Location Address
First Line : 2601 W MAIN ST
Second Line :
City : CARBONDALE
State : IL
Zip : 62901-1031
Country : US
Telephone Number : 618-549-5361
Fax Number : 618-549-5128
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2006
Last Update Date : 07/07/2011

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