Basic Information
| Provider Information | |||||||||
| NPI: | 1912513854 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KLUCAS | ||||||||
| FirstName: | CHRISTOPHER | ||||||||
| MiddleName: | DAVID | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2313 E SAINT FRANCIS ST | ||||||||
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| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577035968 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6052224225 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1303 N LACROSSE ST | ||||||||
| Address2: | |||||||||
| City: | RAPID CITY | ||||||||
| State: | SD | ||||||||
| PostalCode: | 577016956 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6057552273 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/16/2020 | ||||||||
| LastUpdateDate: | 09/16/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 1258 | SD | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.