Individual
GLENN L NUDELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2191 CHIP DR, LAKE HAVASU CITY, AZ 86406-7645
(928) 486-4387
(928) 302-3515
Mailing address
2191 CHIP DR, LAKE HAVASU CITY, AZ 86406-7645
(928) 486-4387
(928) 302-3515
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
14122
AZ
207R00000X
Internal Medicine Physician
Primary
14122
AZ
207R00000X
Internal Medicine Physician
AN14122
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110044210
RAILROAD MEDICARE
AZ
Enumeration date
08/10/2005
Last updated
07/29/2022
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