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NPI Code Detail

MEDICARE: ROCKY MOUNTAIN UROLOGY LLC

MEDICARE: ROCKY MOUNTAIN UROLOGY LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208800000XUrology Physician24077WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2DB7643OTHERMTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740343359
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROCKY MOUNTAIN UROLOGY LLC
Provider Business Mailing Address
First Line : 1511 PARK AVE
Second Line : SUITE F
City : COLUMBUS
State : WI
Zip : 53925-2401
Country : US
Telephone Number : 920-623-9970
Fax Number : 920-623-9989
Provider Business Practice Location Address
First Line : 1511 PARK AVE
Second Line : SUITE F
City : COLUMBUS
State : WI
Zip : 53925-2401
Country : US
Telephone Number : 920-623-9970
Fax Number : 920-623-9989
Authorized Official
Title or Position : OWNER EMPLOYEE
Name : DR. MICHAEL ERVIN KUGLITSCH
Credential : MD
Telephone Number : 920-623-9970
Provider Enumeration Date : 12/18/2006
Last Update Date : 04/20/2008

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1831384874 — MS. DAWN MARIE FAUST APRN, BC
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Directions to “ROCKY MOUNTAIN UROLOGY LLC ” Practice Location

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