Provider Demographics
NPI:1003832221
Name:KLUTKE, CARL G (MD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:G
Last Name:KLUTKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:C B 8242
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-996-8060
Mailing Address - Fax:314-747-4871
Practice Address - Street 1:1040 N MASON RD
Practice Address - Street 2:STE 122
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-6399
Practice Address - Country:US
Practice Address - Phone:314-996-8060
Practice Address - Fax:314-747-4871
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MOR1K30208800000X
FLME118479208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP01808689OtherCLEAR HEALTH ALLIANCE
FL1193315OtherWELLCARE
MO017010219Medicaid
FL1193315OtherWELLCARE
MO017010219Medicaid
IL$$$$$$$$$Medicaid
FL2405242OtherCIGNA
FLHY050YMedicare PIN
FL013691000Medicaid
MO340007207Medicare PIN
FLHY050ZMedicare PIN
MO017010219Medicare PIN