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NPI Code Detail

MEDICARE: ROCKY MOUNTAIN UROLOGY,LLC

MEDICARE: ROCKY MOUNTAIN UROLOGY,LLC
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
12088P0231XPediatric Urology Physician7089MT

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
4DB7643OTHERMTRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
28N223OTHERIDBC IDAHO
3000010154126OTHERIDREGENCY BLUE SHIELD OF ID
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1689871451
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROCKY MOUNTAIN UROLOGY,LLC
Provider Business Mailing Address
First Line : 1511 PARK AVE
Second Line : SUITE F
City : COLUMBUS
State : WI
Zip : 53925-2401
Country : US
Telephone Number : 920-623-9970
Fax Number : 920-623-9970
Provider Business Practice Location Address
First Line : 1511 PARK AVE
Second Line : SUITE F
City : COLUMBUS
State : WI
Zip : 53925-2401
Country : US
Telephone Number : 920-623-9970
Fax Number : 920-623-9970
Authorized Official
Title or Position : OWNER
Name : DR. MICHAEL ERVIN KUGLITSCH
Credential : MD
Telephone Number : 920-623-9970
Provider Enumeration Date : 06/27/2007
Last Update Date : 04/20/2008

Similar Medicare Providers

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1225088362 — DR. JOHN E. WALZ MD
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1548209695 — HEIDI HUGHES PA-C
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Practice Fax:
1740343359 — ROCKY MOUNTAIN UROLOGY LLC
Practice Location Address:
1511 PARK AVE , SUITE F
COLUMBUS, WI
53925-2401
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Practice Fax: 920-623-9989
1831384874 — MS. DAWN MARIE FAUST APRN, BC
Practice Location Address:
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Practice Fax:

Directions to “ROCKY MOUNTAIN UROLOGY,LLC ” Practice Location

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