MEDICARE: RONALD G. KLUDO D.O.

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	207Q00000X	Family Medicine Physician	OS5844	FL

General Provider Information

NPI Number	:	1689725533
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONALD G. KLUDO D.O.

Provider Business Mailing Address
First Line	:	7653 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2534
Country	:	US
Telephone Number	:	561-434-9066
Fax Number	:	561-434-0222

Provider Business Practice Location Address
First Line	:	7653 LAKE WORTH RD
Second Line	:
City	:	LAKE WORTH
State	:	FL
Zip	:	33467-2534
Country	:	US
Telephone Number	:	561-434-9066
Fax Number	:	561-434-0222

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

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/08/2007

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