Individual
GARY MYRON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
350 PELLER RD, LAKE GENEVA, WI 53147-4543
(262) 249-0221
(262) 249-0633
Mailing address
350 PELLER RD, LAKE GENEVA, WI 53147-4543
(262) 249-0221
(262) 249-0633
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
50315-020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1386773174
BCBSWI
WI
05
—
1386773174
—
WI
01
—
1664
MERCYCARE INSURANCE
WI
05
—
34947000
—
WI
01
—
MYRONGAR
MERCYCARE INSURANCE
WI
Enumeration date
03/05/2007
Last updated
05/08/2019
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