Healthcare Provider Details

I. General information

NPI: 1104330943
Provider Name (Legal Business Name): KUGLITSCH ENTERPRISES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2017
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3414 NW CACHE RD STE F
LAWTON OK
73505-3878
US

IV. Provider business mailing address

3414 NW CACHE RD STE F
LAWTON OK
73505-3878
US

V. Phone/Fax

Practice location:
  • Phone: 580-771-2008
  • Fax: 817-771-2030
Mailing address:
  • Phone: 580-771-2008
  • Fax: 580-771-2030

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL KUGLITSCH
Title or Position: OWNER
Credential: MD
Phone: 920-344-5237