Provider Demographics
NPI:1528055936
Name:NOGLER, CALVIN D (MD)
Entity type:Individual
Prefix:
First Name:CALVIN
Middle Name:D
Last Name:NOGLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1866
Mailing Address - Street 2:
Mailing Address - City:GREEN BAY
Mailing Address - State:WI
Mailing Address - Zip Code:54305-1866
Mailing Address - Country:US
Mailing Address - Phone:920-445-7222
Mailing Address - Fax:920-445-7289
Practice Address - Street 1:441 FRENCH ST
Practice Address - Street 2:
Practice Address - City:PESHTIGO
Practice Address - State:WI
Practice Address - Zip Code:54157-1203
Practice Address - Country:US
Practice Address - Phone:715-582-9949
Practice Address - Fax:715-582-4464
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2016-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI27288020207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30666400Medicaid
WI523492113007OtherBCBS
523492113OtherCHAMPUS/TRICARE
080171064OtherRR MEDICARE
WI523492113007OtherBCBS
B55390Medicare UPIN