Individual
DR. GLENN A SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2219 GARFIELD ST, TWO RIVERS, WI 54241
(920) 793-2281
(920) 793-3669
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
(800) 326-2250
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
31392
WI
208100000X
Physical Medicine & Rehabilitation Physician
31392
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
31673600
—
WI
Enumeration date
08/24/2006
Last updated
01/15/2024
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