Provider Demographics
NPI:1629077110
Name:FRANKE, GLENNA CAROLYN (DO)
Entity Type:Individual
Prefix:DR
First Name:GLENNA
Middle Name:CAROLYN
Last Name:FRANKE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3394 MCKELVEY RD
Mailing Address - Street 2:STE 113
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044-2531
Mailing Address - Country:US
Mailing Address - Phone:314-291-3409
Mailing Address - Fax:314-739-6798
Practice Address - Street 1:3394 MCKELVEY RD
Practice Address - Street 2:STE 113
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044-2531
Practice Address - Country:US
Practice Address - Phone:314-291-3409
Practice Address - Fax:314-739-6798
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-18
Last Update Date:2010-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO29322208D00000X
IL036056844208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
000014095Medicare ID - Type Unspecified
E37290Medicare UPIN