Provider Demographics
NPI:1265514731
Name:MEINTS, GLENN ROBERT (DPM)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ROBERT
Last Name:MEINTS
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55812-1427
Mailing Address - Country:US
Mailing Address - Phone:218-724-9581
Mailing Address - Fax:
Practice Address - Street 1:324 W SUPERIOR ST
Practice Address - Street 2:STE 517
Practice Address - City:DULUTH
Practice Address - State:MN
Practice Address - Zip Code:55802-1760
Practice Address - Country:US
Practice Address - Phone:218-722-0326
Practice Address - Fax:218-722-4403
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN532213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN2700690OtherMEDICA
MN480034106OtherRAILROAD MEDICARE
MN77342MEOtherBLUE CROSS BLUE SHIELD
MN767218700Medicaid
MN480034106OtherRAILROAD MEDICARE
MNU50287Medicare UPIN