Provider Demographics
NPI:1881649390
Name:KLUEGER, DEBRA BETH (DO)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:BETH
Last Name:KLUEGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 KIRTS BLVD
Mailing Address - Street 2:STE 200
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48084-4140
Mailing Address - Country:US
Mailing Address - Phone:248-824-6060
Mailing Address - Fax:
Practice Address - Street 1:500 KIRTS BLVD STE 200
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-4140
Practice Address - Country:US
Practice Address - Phone:248-824-6060
Practice Address - Fax:248-686-0772
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101016699207R00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4871793Medicaid
MI4871793Medicaid