Provider Demographics
NPI:1598712788
Name:BUTTERMANN, GLENN ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ROBIN
Last Name:BUTTERMANN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1950 NORTHWESTERN AVE S
Mailing Address - Street 2:STE 102
Mailing Address - City:STILLWATER
Mailing Address - State:MN
Mailing Address - Zip Code:55082-7615
Mailing Address - Country:US
Mailing Address - Phone:651-430-3800
Mailing Address - Fax:651-430-3827
Practice Address - Street 1:1835 COUNTY ROAD C W STE 150
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1343
Practice Address - Country:US
Practice Address - Phone:651-430-3800
Practice Address - Fax:651-430-1447
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2021-03-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN32111207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN00901903OtherMEDICA
26683OtherARAZ
MN267312600Medicaid
MN8K171BUOtherBLUE CROSS BLUE SHEILD
MN115119OtherUCARE
MN1008807OtherPREFERRED ONE
HP17751OtherHEALTHPARTNERS
200036945OtherRAIL ROAD MEDICARE
WI32139000Medicaid
MN8K171BUOtherBLUE CROSS BLUE SHEILD
MN267312600Medicaid
WI32139000Medicaid
MND83686Medicare UPIN