Provider Demographics
NPI:1003800558
Name:DENVER OCCUPATIONAL & AVIATION MED. CLINIC
Entity Type:Organization
Organization Name:DENVER OCCUPATIONAL & AVIATION MED. CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CLARENCE
Authorized Official - Middle Name:J
Authorized Official - Last Name:KLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:303-373-4456
Mailing Address - Street 1:3464 S WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80231-4531
Mailing Address - Country:US
Mailing Address - Phone:303-755-2900
Mailing Address - Fax:303-755-0404
Practice Address - Street 1:3700 HAVANA ST
Practice Address - Street 2:SUITE 200
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80239-3240
Practice Address - Country:US
Practice Address - Phone:303-373-4456
Practice Address - Fax:303-373-4501
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO16150207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC49821Medicaid
COKW63304OtherBLUESHIELD
CO=========01OtherPACIFICARE
COF16334Medicare UPIN
COC49821Medicaid