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General NPI Number Information
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NPI Number | 1760997092
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Entity Type | Organization
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Legal Business Name | LAWTON UROLOGY
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Dates
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Enumeration Date | 12/08/2017
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Last Update Date | 06/16/2018
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Provider Practice Location Address
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Address Line | 3414 NW CACHE RD STE F
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City | LAWTON
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State | OK
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Zip | 73505-3878
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Country | US
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Telephone | 580-771-2008
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Fax |
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Provider Business Mailing Address
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Address Line | 1370 N INTERSTATE DR STE 154
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City | NORMAN
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State | OK
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Zip | 73072-3377
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Country | US
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Telephone | 405-307-6668
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Fax | 405-701-6170
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL KUGLITSCH
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Credential | MD
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Telephone | 920-344-5237
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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