Provider Demographics
NPI:1922410018
Name:KLUZ, AGATA
Entity Type:Individual
Prefix:
First Name:AGATA
Middle Name:
Last Name:KLUZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2770 S CEDAR GLEN DR
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON HTS
Mailing Address - State:IL
Mailing Address - Zip Code:60005-5301
Mailing Address - Country:US
Mailing Address - Phone:847-222-3553
Mailing Address - Fax:
Practice Address - Street 1:2770 S CEDAR GLEN DR
Practice Address - Street 2:
Practice Address - City:ARLINGTON HTS
Practice Address - State:IL
Practice Address - Zip Code:60005-5301
Practice Address - Country:US
Practice Address - Phone:847-222-3553
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-23
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program