Provider Demographics
NPI:1306867320
Name:KLUKA, EVELYN A (MD)
Entity type:Individual
Prefix:
First Name:EVELYN
Middle Name:A
Last Name:KLUKA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:EVELYN
Other - Middle Name:KLUKA
Other - Last Name:MEIER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 191
Mailing Address - Street 2:PROVIDER ENROLLMENT DEPARTMENT
Mailing Address - City:ROCKLAND
Mailing Address - State:DE
Mailing Address - Zip Code:19732-0191
Mailing Address - Country:US
Mailing Address - Phone:407-650-7129
Mailing Address - Fax:302-651-4945
Practice Address - Street 1:5153 NORTH 9TH AVE.
Practice Address - Street 2:NEMOURS CHILDREN'S CLINIC, PENSACOLA
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8785
Practice Address - Country:US
Practice Address - Phone:850-505-4700
Practice Address - Fax:850-505-4714
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17700207RC0000X
FLME113095207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1385808Medicaid
B63921Medicare UPIN