Provider Demographics
NPI:1740382555
Name:RAGALIE, GLENN FRANCIS (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:FRANCIS
Last Name:RAGALIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1621 CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-2541
Mailing Address - Country:US
Mailing Address - Phone:414-258-7498
Mailing Address - Fax:
Practice Address - Street 1:1155 N HONEY CREEK PKWY
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-3189
Practice Address - Country:US
Practice Address - Phone:414-615-5936
Practice Address - Fax:414-615-5927
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2017-01-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI21819207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI30330900Medicaid
WIB55902Medicare UPIN