Provider Demographics
NPI:1275647877
Name:GLOTZBACH, ELLEN SUE (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:SUE
Last Name:GLOTZBACH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MRS
Other - First Name:ELLEN
Other - Middle Name:SUE
Other - Last Name:ALLEGRI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1004 CARONDELET DR
Mailing Address - Street 2:SUITE 310
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4802
Mailing Address - Country:US
Mailing Address - Phone:816-942-5437
Mailing Address - Fax:816-942-4830
Practice Address - Street 1:1004 CARONDELET DR
Practice Address - Street 2:SUITE 310
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4802
Practice Address - Country:US
Practice Address - Phone:816-942-5437
Practice Address - Fax:816-942-4830
Is Sole Proprietor?:No
Enumeration Date:2006-08-19
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6H97208000000X
KS0422185208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics