Provider Demographics
NPI:1376765420
Name:KLUGE, DAVID (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:KLUGE
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 1:1400 29TH ST S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5353
Mailing Address - Country:US
Mailing Address - Phone:406-454-2171
Mailing Address - Fax:406-771-3021
Practice Address - Street 1:3000 15TH AVE S
Practice Address - Street 2:GREAT FALLS CLINIC SPECIALTIY BUILDING
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5240
Practice Address - Country:US
Practice Address - Phone:406-771-3437
Practice Address - Fax:406-771-3464
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT11934207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1376765420Medicaid
MT011002946Medicare PIN