Provider Demographics
NPI:1407846496
Name:KLUZNIK, JOHN COOKE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:COOKE
Last Name:KLUZNIK
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 1:1042 SUMMIT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-3003
Mailing Address - Country:US
Mailing Address - Phone:651-293-1076
Mailing Address - Fax:
Practice Address - Street 1:2960 WINNETKA AVE N
Practice Address - Street 2:SUITE 208
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55427-2853
Practice Address - Country:US
Practice Address - Phone:763-512-1090
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN216652084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
1567993OtherMEDMA
HP35359OtherHP
1567993OtherADVAN
1015832OtherPEAK
1567993OtherUHC U
49A22KLOtherEPNI
49A22KLOtherCCS
1015832OtherPRE 1
1015832OtherP1CHP
1567993OtherUHIC
1567993OtherUHC
49A22KLOtherB L
49A22KLOtherANTHE
1567993OtherMEDCA
49A22KLOtherBCBS
HP35359OtherHP