Provider Demographics
NPI:1649204645
Name:FRUEHBRODT-GLENZINSKI, JUDY LYNN (MD)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:LYNN
Last Name:FRUEHBRODT-GLENZINSKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:LYNN
Other - Last Name:FRUEHBRODT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 STATE AVE
Mailing Address - Street 2:
Mailing Address - City:FARIBAULT
Mailing Address - State:MN
Mailing Address - Zip Code:55021-6319
Mailing Address - Country:US
Mailing Address - Phone:507-333-3300
Mailing Address - Fax:507-333-3214
Practice Address - Street 1:300 STATE AVE
Practice Address - Street 2:
Practice Address - City:FARIBAULT
Practice Address - State:MN
Practice Address - Zip Code:55021
Practice Address - Country:US
Practice Address - Phone:507-333-3300
Practice Address - Fax:507-333-3214
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2021-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN41619207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN603219200Medicaid
080136009OtherRAIL ROAD MEDICARE
MN080007759Medicare ID - Type Unspecified
F95221Medicare UPIN
IA0517052Medicare ID - Type Unspecified