Provider Demographics
NPI:1841224557
Name:VERBRUGGE, GLENN P (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:P
Last Name:VERBRUGGE
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 1:927 CARMEL ST
Mailing Address - Street 2:
Mailing Address - City:CADILLAC
Mailing Address - State:MI
Mailing Address - Zip Code:49601-2547
Mailing Address - Country:US
Mailing Address - Phone:231-876-3876
Mailing Address - Fax:231-775-1115
Practice Address - Street 1:927 CARMEL ST
Practice Address - Street 2:
Practice Address - City:CADILLAC
Practice Address - State:MI
Practice Address - Zip Code:49601-2547
Practice Address - Country:US
Practice Address - Phone:231-876-3876
Practice Address - Fax:231-775-1115
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIGV027634208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4084813Medicaid
MI4084813Medicaid