Provider Demographics
NPI:1447928080
Name:KLUG, MAXWELL
Entity type:Individual
Prefix:MR
First Name:MAXWELL
Middle Name:
Last Name:KLUG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:212 S FRANCISCO AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60612-3618
Mailing Address - Country:US
Mailing Address - Phone:773-243-7574
Mailing Address - Fax:
Practice Address - Street 1:212 S FRANCISCO AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3618
Practice Address - Country:US
Practice Address - Phone:773-243-7574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-30
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker