MEDICARE: DR. MIROSLAW K ROGALSKI MD

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	207RA0000X	Adolescent Medicine (Internal Medicine) Physician	27310-020	WI

General Provider Information

NPI Number	:	1598868630
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MIROSLAW K ROGALSKI MD

Provider Business Mailing Address
First Line	:	21425 SPRING ST
Second Line	:
City	:	UNION GROVE
State	:	WI
Zip	:	53182-9707
Country	:	US
Telephone Number	:	262-878-2411
Fax Number	:	262-878-2922

Provider Business Practice Location Address
First Line	:	21425 SPRING ST
Second Line	:
City	:	UNION GROVE
State	:	WI
Zip	:	53182-9707
Country	:	US
Telephone Number	:	262-878-2411
Fax Number	:	262-878-2922

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	07/08/2007

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