Provider Demographics
NPI:1942682455
Name:GK MEDICAL CONSULTING LLC
Entity Type:Organization
Organization Name:GK MEDICAL CONSULTING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:HERMAN
Authorized Official - Last Name:KLUGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-838-0036
Mailing Address - Street 1:1010 WOODMAN DR
Mailing Address - Street 2:SUITE 220
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-1400
Mailing Address - Country:US
Mailing Address - Phone:937-258-0682
Mailing Address - Fax:
Practice Address - Street 1:1010 WOODMAN DR
Practice Address - Street 2:SUITE 220
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-1400
Practice Address - Country:US
Practice Address - Phone:937-258-0682
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-20
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.057549207RA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty