Provider Demographics
NPI:1790701019
Name:LOPATE, GLENN (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:
Last Name:LOPATE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:660 S EUCLID AVE
Mailing Address - Street 2:CB 8111
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63110-1010
Mailing Address - Country:US
Mailing Address - Phone:314-362-1408
Mailing Address - Fax:314-362-3752
Practice Address - Street 1:517 S EUCLID AVE
Practice Address - Street 2:DIV NEUROLOGY NEUROMUSCULAR, G FL
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1007
Practice Address - Country:US
Practice Address - Phone:314-362-1408
Practice Address - Fax:314-362-3752
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2021-11-15
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Provider Licenses
StateLicense IDTaxonomies
MOR6J052084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO202721528Medicaid
ILENROLLEDMedicaid
MO067010101Medicaid
MO130011704Medicare PIN