Provider Demographics
NPI:1609848654
Name:KUGLAR, WILLIAM R (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:R
Last Name:KUGLAR
Suffix:
Gender:M
Credentials:DPM
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Mailing Address - Street 1:8100 34TH AVE S
Mailing Address - Street 2:MS 21110Q
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1672
Mailing Address - Country:US
Mailing Address - Phone:952-883-5790
Mailing Address - Fax:952-883-5395
Practice Address - Street 1:401 PHALEN BLVD
Practice Address - Street 2:MAIL STOP 41104E
Practice Address - City:ST PAUL
Practice Address - State:MN
Practice Address - Zip Code:55101-5302
Practice Address - Country:US
Practice Address - Phone:651-254-8380
Practice Address - Fax:651-254-8386
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2011-12-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN452213ES0131X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN074025000Medicaid
MN074025000Medicaid
T14289Medicare UPIN