Fuglestad, Loren C

Fuglestad, Loren C is an individual health care provider with primary practice located at 2714 Riverview Dr , Green Bay WI 54313-6715. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Fuglestad, Loren C can be contacted via phone (920) 430-4760.

Contact Information

Primary practice address
2714 Riverview Dr Green Bay WI 54313-6715
Phone: (920) 430-4760
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X 35673 Wisconsin

Profile Details

NPI number 1669456463
LBN Legal business name Fuglestad, Loren C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 5th, 2005
Last updated Feb 19th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1669456463 NPPES
Wisconsin Other P01404701 RAIL ROAD MEDICARE
Wisconsin Other 35673 RAIL ROAD MEDICARE

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