Basic Information
| Provider Information | |||||||||
| NPI: | 1528055936 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NOGLER | ||||||||
| FirstName: | CALVIN | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1866 | ||||||||
| Address2: | |||||||||
| City: | GREEN BAY | ||||||||
| State: | WI | ||||||||
| PostalCode: | 543051866 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9204457222 | ||||||||
| FaxNumber: | 9204457289 | ||||||||
| Practice Location | |||||||||
| Address1: | 441 FRENCH ST | ||||||||
| Address2: | |||||||||
| City: | PESHTIGO | ||||||||
| State: | WI | ||||||||
| PostalCode: | 541571203 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7155829949 | ||||||||
| FaxNumber: | 7155824464 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2005 | ||||||||
| LastUpdateDate: | 10/28/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 27288020 | WI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 30666400 | 05 | WI | MEDICAID | 523492113007 | 01 | WI | BCBS | OTHER | 523492113 | 01 | CHAMPUS/TRICARE | OTHER | 080171064 | 01 | RR MEDICARE | OTHER |