Provider Demographics
NPI:1689725533
Name:KLUDO, RONALD G (DO)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:G
Last Name:KLUDO
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 1:7653 LAKE WORTH RD
Mailing Address - Street 2:
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-2534
Mailing Address - Country:US
Mailing Address - Phone:561-434-9066
Mailing Address - Fax:561-434-0222
Practice Address - Street 1:7653 LAKE WORTH RD
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-2534
Practice Address - Country:US
Practice Address - Phone:561-434-9066
Practice Address - Fax:561-434-0222
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5844207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLB36999Medicare UPIN
FL80855Medicare ID - Type UnspecifiedPROVIDER ID