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NPI Code Detail

MEDICARE: DR. DENNIS KENNETH IGLAR M.D.

MEDICARE: DR. DENNIS KENNETH IGLAR 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
1207Q00000XFamily Medicine PhysicianG22478CA
2207Q00000XFamily Medicine Physician17633WI

General Provider Information

NPI Number : 1578556809
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DENNIS KENNETH IGLAR M.D.
Provider Business Mailing Address
First Line : 2750 GOLF RD
Second Line : PROHEALTH CARE MEDICAL ASSOCIATES INC
City : DELAFIELD
State : WI
Zip : 53018-2062
Country : US
Telephone Number : 262-928-3270
Fax Number :
Provider Business Practice Location Address
First Line : 275 N EL CIELO RD
Second Line :
City : PALM SPRINGS
State : CA
Zip : 92262-6972
Country : US
Telephone Number : 760-320-8814
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2005
Last Update Date : 04/25/2012

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