Individual
DR. MARK T KLUCKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
4 MEMORIAL DR STE 230, ALTON, IL 62002-6704
(618) 463-7874
Mailing address
PO BOX 959203, SAINT LOUIS, MO 63195-1281
(618) 463-7874
(618) 463-7846
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036077227
IL
207RG0100X
Gastroenterology Physician
036.077227
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036077227
—
IL
01
—
100013015
RAILROAD MEDICARE
IL
Enumeration date
08/23/2006
Last updated
09/19/2025
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