Provider Demographics
NPI:1154469187
Name:OSTERWEIL, GLENN H (DPM)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:H
Last Name:OSTERWEIL
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2560 E HWY 50 STE 106
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-8411
Mailing Address - Country:US
Mailing Address - Phone:407-900-7259
Mailing Address - Fax:352-877-4182
Practice Address - Street 1:2560 E HWY 50 STE 106
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-8411
Practice Address - Country:US
Practice Address - Phone:407-900-7259
Practice Address - Fax:352-877-4182
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2018-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2136213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL055217800Medicaid
FL480032681OtherRAILROAD MEDICARE
FL055217801Medicaid
FL65195AMedicare ID - Type Unspecified
FL055217800Medicaid
FL480032681OtherRAILROAD MEDICARE