Individual
DR. GLEN E BURMEISTER
Active
Individual
DR. GLEN E BURMEISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
17672
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01176726
—
CO
01
—
02312247
NY MEDICAID
NY
05
—
10025709000
—
NE
01
—
104686051
MI MEDICAID
MI
05
—
1366428500
—
MT
05
—
1366428500
—
WY
05
—
1679513196
—
UT
01
—
200418410A
KS MEDICAID
KS
01
—
300048674
RR MCRE MIC
CO
01
—
300090005
RR MCRE RIA
CO
01
—
300090006
RR MCRE DIA
CO
01
—
53212901
TX MEDICAID
TX
05
—
84-0597929
—
NE
01
—
8492233
WA MEDICAID
WA
05
—
85429562
—
NM
01
—
922288
AZ MEDICAID
AZ
01
—
CO305780
MEDICARE TRAILBLAZER
NE
01
—
NA1214056
WPS NA 1214 RIN MCR PIN
NE
01
—
NA1215056
WPS NA 1215 RIN MCR PIN
NE
01
—
XPY201235
CA MEDICAID
CA
Enumeration date
12/20/2005
Last updated
05/25/2011
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