Healthcare Provider Details

I. General information

NPI: 1255439436
Provider Name (Legal Business Name): MORRIS A KUGLER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 02/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2227 VADALABENE DR STE 300
MARYVILLE IL
62062-5823
US

IV. Provider business mailing address

2227 VADALABENE DR STE 300
MARYVILLE IL
62062-5823
US

V. Phone/Fax

Practice location:
  • Phone: 618-288-7485
  • Fax: 618-288-9086
Mailing address:
  • Phone: 618-288-7485
  • Fax: 618-288-9086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036041568
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: