Provider Demographics
NPI:1588635239
Name:AGUILAR, EULOGIO G (MD)
Entity Type:Individual
Prefix:
First Name:EULOGIO
Middle Name:G
Last Name:AGUILAR
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 PARKER ST
Mailing Address - Street 2:
Mailing Address - City:BOSCOBEL
Mailing Address - State:WI
Mailing Address - Zip Code:53805-1642
Mailing Address - Country:US
Mailing Address - Phone:608-375-6217
Mailing Address - Fax:608-375-5463
Practice Address - Street 1:220 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:FENNIMORE
Practice Address - State:WI
Practice Address - Zip Code:53809-1030
Practice Address - Country:US
Practice Address - Phone:608-822-3737
Practice Address - Fax:608-882-3738
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27146-020207P00000X
WI27146-20207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30696100Medicaid
WI000124160Medicare PIN
WI010038379Medicare PIN
WI30696100Medicaid
WI000100486Medicare PIN