Organization
ROCKY MOUNTAIN UROLOGY,LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL ERVIN KUGLITSCH MD (OWNER)
(920) 623-9970
Entity
Organization
Contact information
Practice address
1511 PARK AVE, SUITE F, COLUMBUS, WI 53925-2401
(920) 623-9970
(920) 623-9970
Mailing address
1511 PARK AVE, SUITE F, COLUMBUS, WI 53925-2401
(920) 623-9970
(920) 623-9970
Taxonomy
Speciality
Code
Description
License number
State
2088P0231X
Pediatric Urology Physician
Primary
7089
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010154126
REGENCY BLUE SHIELD OF ID
ID
05
—
0020103002
—
ID
05
—
0081226
—
MT
05
—
30673100
—
WI
01
—
8N223
BC IDAHO
ID
01
—
DB7643
RAILROAD MEDICARE
MT
Enumeration date
06/27/2007
Last updated
04/20/2008
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