Provider Demographics
NPI:1629066089
Name:SILVERSTEIN, GLENN (DPM)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:SILVERSTEIN
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 1:8111 S LA ROSA DR
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85284-1418
Mailing Address - Country:US
Mailing Address - Phone:602-405-1227
Mailing Address - Fax:
Practice Address - Street 1:7400 E OSBORN RD
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-6432
Practice Address - Country:US
Practice Address - Phone:480-583-0500
Practice Address - Fax:480-583-2775
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-10
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0388213ES0103X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ067513Medicaid
T51334Medicare UPIN
Z142716Medicare PIN
ZDPM388Medicare ID - Type Unspecified
AZ067513Medicaid