Provider Demographics
NPI:1205822277
Name:KLUFAS, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:KLUFAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 BROAD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-6919
Mailing Address - Country:US
Mailing Address - Phone:401-726-1048
Mailing Address - Fax:401-724-0896
Practice Address - Street 1:525 BROAD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-6919
Practice Address - Country:US
Practice Address - Phone:401-726-1048
Practice Address - Fax:401-724-0896
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-23
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6939207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI303185OtherTUFTS
RI0400509OtherUNITED HEALTH
RI202292OtherBLUECHIP
RI9000376Medicaid
RI3766OtherBLUECROSS
RI9000376Medicaid
RI202292OtherBLUECHIP