Provider Demographics
NPI:1578719365
Name:KLUETZ, JOSHUA T (DO)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:T
Last Name:KLUETZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E 75TH ST
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7930 N SHADELAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46250-2943
Practice Address - Country:US
Practice Address - Phone:317-497-6024
Practice Address - Fax:317-497-2507
Is Sole Proprietor?:No
Enumeration Date:2008-08-12
Last Update Date:2024-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02004210A207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201157760Medicaid
INP01221104OtherRR MEDICARE PTAN
INP01221104OtherRR MEDICARE PTAN
IN201157760Medicaid