Provider Demographics
NPI:1144670597
Name:NATHAN A. KLUDT, MD, INC
Entity type:Organization
Organization Name:NATHAN A. KLUDT, MD, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:KLUDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-870-7100
Mailing Address - Street 1:1805 N CALIFORNIA ST STE 405
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-6033
Mailing Address - Country:US
Mailing Address - Phone:209-870-7100
Mailing Address - Fax:209-870-7116
Practice Address - Street 1:1805 N CALIFORNIA ST STE 405
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-6033
Practice Address - Country:US
Practice Address - Phone:209-870-7100
Practice Address - Fax:209-870-7116
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA110013261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty