Provider Demographics
NPI:1255359733
Name:APPLEGARTH, WILLIAM GRANT (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:GRANT
Last Name:APPLEGARTH
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 1:1510 MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:LA PORTE
Mailing Address - State:IN
Mailing Address - Zip Code:46350-5150
Mailing Address - Country:US
Mailing Address - Phone:219-324-4947
Mailing Address - Fax:
Practice Address - Street 1:1861 STURDY ROAD
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-8017
Practice Address - Country:US
Practice Address - Phone:219-548-0360
Practice Address - Fax:219-548-0358
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039449A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
INF27888Medicare UPIN
IN327770Medicare ID - Type Unspecified