Provider Demographics
NPI:1942396718
Name:POPLAR, CLIFFORD ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:ROBERT
Last Name:POPLAR
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 1:915 E GENEVA ST
Mailing Address - Street 2:PO BOX 467
Mailing Address - City:DELAVAN
Mailing Address - State:WI
Mailing Address - Zip Code:53115-1922
Mailing Address - Country:US
Mailing Address - Phone:262-728-2651
Mailing Address - Fax:262-728-2728
Practice Address - Street 1:915 GENEVA STREET
Practice Address - Street 2:
Practice Address - City:DELAVAN
Practice Address - State:WI
Practice Address - Zip Code:53115
Practice Address - Country:US
Practice Address - Phone:262-728-2651
Practice Address - Fax:262-728-2728
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI28415207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30856400Medicaid
WI30856400Medicaid
WI000065024Medicare PIN