Individual
MR. GLENN MARTIN SKATTEBO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7684 N 51ST ST, BROWN DEER, WI 53223-4353
(414) 430-5079
Mailing address
7684 N 51ST ST, BROWN DEER, WI 53223-4353
(414) 430-5079
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
S310-2934-3090-03
WI
Other
Enumeration date
10/21/2018
Last updated
10/21/2018
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