Basic Information
| Provider Information | |||||||||
| NPI: | 1487638177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLUGER | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 WHITING HILL RD | ||||||||
| Address2: | |||||||||
| City: | BREWER | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044121005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079735000 | ||||||||
| FaxNumber: | 2079735042 | ||||||||
| Practice Location | |||||||||
| Address1: | 885 UNION ST | ||||||||
| Address2: | SUITE 145 | ||||||||
| City: | BANGOR | ||||||||
| State: | ME | ||||||||
| PostalCode: | 044013083 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2079739595 | ||||||||
| FaxNumber: | 2079737898 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2005 | ||||||||
| LastUpdateDate: | 12/12/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207YX0007X | 012600 | ME | Y | Allopathic & Osteopathic Physicians | Otolaryngology | Plastic Surgery within the Head & Neck |
ID Information
| ID | Type | State | Issuer | Description | 002412 | 01 | ME | ANTHEM BLUE SHIELD | OTHER | 1040656 | 01 | ME | AETNA INDIV # | OTHER | 620012901 | 01 | ME | CIGNA INDIV # | OTHER | 306530099 | 05 | ME | MEDICAID | 040013980 | 01 | ME | RAILROAD INDIV PROV # | OTHER | 110570001 | 05 | ME | MEDICAID | 100224700 | 01 | ME | DEPT OF LABOR GROUP # | OTHER | 110570000 | 05 | ME | MEDICAID |