Provider Demographics
NPI:1336147636
Name:KLUGE, RONICA M (MD)
Entity Type:Individual
Prefix:
First Name:RONICA
Middle Name:M
Last Name:KLUGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7006
Mailing Address - Street 2:
Mailing Address - City:FT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33911-7006
Mailing Address - Country:US
Mailing Address - Phone:239-948-3761
Mailing Address - Fax:239-931-3454
Practice Address - Street 1:24600 S TAMIAMI TRL
Practice Address - Street 2:SUITE 400
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-7022
Practice Address - Country:US
Practice Address - Phone:239-948-3761
Practice Address - Fax:239-931-3454
Is Sole Proprietor?:No
Enumeration Date:2005-07-11
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME24849207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL063106000Medicaid
FL063106000Medicaid
FL09645ZMedicare ID - Type Unspecified