Provider Demographics
NPI:1699975920
Name:MICHAEL E. KLUFAS, MD
Entity type:Organization
Organization Name:MICHAEL E. KLUFAS, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:E
Authorized Official - Last Name:KLUFAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:401-726-1048
Mailing Address - Street 1:525 BROAD ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:CUMBERLAND
Mailing Address - State:RI
Mailing Address - Zip Code:02864-6919
Mailing Address - Country:US
Mailing Address - Phone:401-726-1048
Mailing Address - Fax:401-724-0896
Practice Address - Street 1:525 BROAD ST
Practice Address - Street 2:SUITE 103
Practice Address - City:CUMBERLAND
Practice Address - State:RI
Practice Address - Zip Code:02864-6919
Practice Address - Country:US
Practice Address - Phone:401-726-1048
Practice Address - Fax:401-724-0896
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2014-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI6939207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9000376OtherMEDICAID
RI202292OtherBLUECHIP
RIMK35773Medicaid
RI9000376OtherMEDICAID
RIC89807Medicare UPIN