Provider Demographics
NPI:1225009988
Name:KLUGH, SERENA ANN (MD)
Entity Type:Individual
Prefix:
First Name:SERENA
Middle Name:ANN
Last Name:KLUGH
Suffix:
Gender:F
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:PO BOX 400475
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89140-0475
Mailing Address - Country:US
Mailing Address - Phone:702-696-7256
Mailing Address - Fax:702-796-7256
Practice Address - Street 1:9280 W SUNSET RD
Practice Address - Street 2:SUITE 306
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89148-4860
Practice Address - Country:US
Practice Address - Phone:702-696-7256
Practice Address - Fax:702-796-7256
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV11405207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1225009988Medicaid
V105463Medicare PIN
H85461Medicare UPIN
BE117ZMedicare PIN