# MICHAEL K. KLUTH

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1083756795
- **Gender:** Man
- **Credential:** D.D.S.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 12009126 | IN | Yes |

## Other

- **Enumeration date:** 02/12/2007
- **Last updated:** 07/08/2007

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000089901 | ANTHEM BLUE CROSS | IN |
| 01 | — | 784991 | ARMED FORCES | IN |
| 05 | — | 9177506 | — | IL |