Provider Demographics
NPI:1740214980
Name:AKGULIAN, NICHOLAS A (MD)
Entity Type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:A
Last Name:AKGULIAN
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 1:7322 236TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-9664
Mailing Address - Country:US
Mailing Address - Phone:262-577-8460
Mailing Address - Fax:262-843-1424
Practice Address - Street 1:7322 236TH AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-9664
Practice Address - Country:US
Practice Address - Phone:262-577-8460
Practice Address - Fax:262-843-1424
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI36326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI32100000Medicaid
WIG09056Medicare UPIN
WI006232250Medicare PIN