MEDICARE: DR. ELSE UGLUM M.D.

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
1	208000000X	Pediatrics Physician	G078094	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZHCPP486	OTHER	CA	BLUE CROSS OF CALIFORNIA
2	ZZZ52949Z	OTHER	CA	BLUE SHIELD OF CALIFORNIA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	260026968	OTHER	CA	TAX IDENTIFICATION NUMBER

General Provider Information

NPI Number	:	1376549667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELSE UGLUM M.D.

Provider Business Mailing Address
First Line	:	10956 DONNER PASS RD
Second Line	:	STE 130
City	:	TRUCKEE
State	:	CA
Zip	:	96161-4860
Country	:	US
Telephone Number	:	530-587-3523
Fax Number	:	530-582-6192

Provider Business Practice Location Address
First Line	:	10956 DONNER PASS RD
Second Line	:	STE 130
City	:	TRUCKEE
State	:	CA
Zip	:	96161-4860
Country	:	US
Telephone Number	:	530-587-3523
Fax Number	:	530-582-6192

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2005
Last Update Date	:	01/27/2012

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Directions to “ DR. ELSE UGLUM M.D.” Practice Location

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