Provider Demographics
NPI:1639138381
Name:ALDINGER, GLENN E (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:E
Last Name:ALDINGER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 E WISCONSIN AVE
Mailing Address - Street 2:SUITE 2000
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53202-4815
Mailing Address - Country:US
Mailing Address - Phone:414-290-6720
Mailing Address - Fax:414-290-6755
Practice Address - Street 1:111 E WISCONSIN AVE
Practice Address - Street 2:SUITE 2000
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53202-4815
Practice Address - Country:US
Practice Address - Phone:414-290-6720
Practice Address - Fax:414-290-6755
Is Sole Proprietor?:No
Enumeration Date:2006-03-21
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI20120207P00000X
IL036049989207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036049989Medicaid
WI30784000Medicaid
MI104160620Medicaid
LA1636398Medicaid
WI30784000Medicaid
WI002171116Medicare ID - Type Unspecified
MI104160620Medicaid
WI000707660Medicare ID - Type Unspecified
WI000132280Medicare ID - Type Unspecified
ILL64092Medicare ID - Type Unspecified
WI000132350Medicare ID - Type Unspecified
WI002110006Medicare ID - Type Unspecified
WI002145034Medicare ID - Type Unspecified
WI000117130Medicare ID - Type Unspecified
B85016Medicare UPIN
LA1636398Medicaid