Individual
DR. JESSICA J KLUETZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
355 W 16TH ST, SUITE 4300, INDIANAPOLIS, IN 46202-2207
(317) 963-7077
(317) 963-7068
Mailing address
250 N SHADELAND AVE, STE 130 PROVIDER ENROLLMENT, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
125.056282
IL
208100000X
Physical Medicine & Rehabilitation Physician
Primary
02004220A
IN
208100000X
Physical Medicine & Rehabilitation Physician
125.056282
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
201162640
—
IN
Enumeration date
06/24/2009
Last updated
02/06/2014
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