MEDICARE: JOSHUA T KLUETZ 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	207QS0010X	Sports Medicine (Family Medicine) Physician	02004210A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P01221104	OTHER	IN	RR MEDICARE PTAN

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

General Provider Information

NPI Number	:	1578719365
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA T KLUETZ DO

Provider Business Mailing Address
First Line	:	6626 E 75TH ST
Second Line	:	SUITE 500
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2805
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7930 N SHADELAND AVE STE 200
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46250-2943
Country	:	US
Telephone Number	:	317-497-6024
Fax Number	:	317-497-2507

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

Provider Enumeration Date	:	08/12/2008
Last Update Date	:	01/19/2024

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Directions to “ JOSHUA T KLUETZ DO” Practice Location

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