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NPI Code Detail

MEDICARE: DR. BRUCE EUGENE KLOSTERHOFF M.D.

MEDICARE: DR. BRUCE EUGENE KLOSTERHOFF 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
12084P0800XPsychiatry Physician015141KS

General Provider Information

NPI Number : 1447215454
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRUCE EUGENE KLOSTERHOFF M.D.
Provider Business Mailing Address
First Line : 400 KISIWA VILLAGE RD
Second Line :
City : HUTCHINSON
State : KS
Zip : 67502-4500
Country : US
Telephone Number : 620-665-2240
Fax Number : 620-665-2276
Provider Business Practice Location Address
First Line : 1715 E 23RD AVE
Second Line :
City : HUTCHINSON
State : KS
Zip : 67502-1105
Country : US
Telephone Number : 620-665-2240
Fax Number : 620-665-2276
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2006
Last Update Date : 07/08/2007

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