Provider Demographics
NPI:1427005040
Name:KLUSSMANN, KURT GERNOT (MD)
Entity Type:Individual
Prefix:
First Name:KURT
Middle Name:GERNOT
Last Name:KLUSSMANN
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 1:9621 RIDGETOP BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-8502
Mailing Address - Country:US
Mailing Address - Phone:360-782-1304
Mailing Address - Fax:
Practice Address - Street 1:2200 NW MYHRE RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7681
Practice Address - Country:US
Practice Address - Phone:360-830-1304
Practice Address - Fax:360-830-1380
Is Sole Proprietor?:No
Enumeration Date:2006-05-28
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00030021207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
180015852OtherRAILROAD MEDICARE
WA8932637OtherCRIME VICTIMS COMP
WA43628OtherLABOR & INDUSTRIES
KL3250OtherREGENCE BLUE SHIELD
4606168OtherAETNA
WA8148934Medicaid
WA8148934Medicaid
180015852OtherRAILROAD MEDICARE
G8900009Medicare PIN
G8879702Medicare PIN
WAG115136427Medicare PIN
WAG000250511Medicare PIN
4606168OtherAETNA
WA8148934Medicaid
WAG000250441Medicare PIN
WAG000250641Medicare PIN
KL3250OtherREGENCE BLUE SHIELD
WAGAB05080Medicare PIN