Individual
GLENN GEORGE BETRUS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1037 WATER ST, SUITE 1, PORT HURON, MI 48060-4408
(810) 984-4194
(810) 984-4674
Mailing address
1037 WATER ST, SUITE 1, PORT HURON, MI 48060-4408
(810) 984-4194
(810) 984-4674
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
4301052886
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102916887
—
MI
01
—
540G41006
BLUE CROSS
MI
Enumeration date
07/21/2006
Last updated
07/08/2008
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