Basic Information
| Provider Information | |||||||||
| NPI: | 1609848654 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KUGLAR | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | DPM | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8100 34TH AVE S | ||||||||
| Address2: | MS 21110Q | ||||||||
| City: | BLOOMINGTON | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554251672 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9528835790 | ||||||||
| FaxNumber: | 9528835395 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 PHALEN BLVD | ||||||||
| Address2: | MAIL STOP 41104E | ||||||||
| City: | ST PAUL | ||||||||
| State: | MN | ||||||||
| PostalCode: | 551015302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6512548380 | ||||||||
| FaxNumber: | 6512548386 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/03/2006 | ||||||||
| LastUpdateDate: | 12/01/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0131X | 452 | MN | N | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot Surgery | 213E00000X | 452 | MN | Y | Podiatric Medicine & Surgery Service Providers | Podiatrist |
ID Information
| ID | Type | State | Issuer | Description | 074025000 | 05 | MN | MEDICAID |