Provider Demographics
NPI:1659982924
Name:KLONDIKE MEDICAL GROUP, LLC
Entity Type:Organization
Organization Name:KLONDIKE MEDICAL GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:NAGARAJ
Authorized Official - Middle Name:V
Authorized Official - Last Name:KUNDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-312-5588
Mailing Address - Street 1:11520 SAINT CHARLES ROCK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2732
Mailing Address - Country:US
Mailing Address - Phone:314-312-5588
Mailing Address - Fax:
Practice Address - Street 1:2421 E TUDOR RD STE 105
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99507-1166
Practice Address - Country:US
Practice Address - Phone:314-402-7432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-11
Last Update Date:2021-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207QS1201XAllopathic & Osteopathic PhysiciansFamily MedicineSleep MedicineGroup - Multi-Specialty