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Organization

GLENN A. HANSEN, D.P.M.

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. GLENN A. HANSEN D.P.M. (SOLE PROPRIETOR)
(920) 499-1177
Entity
Organization

Contact information

Practice address
2331 S ONEIDA ST, GREEN BAY, WI 54304-5267
(920) 499-1177
(920) 499-5398
Mailing address
2331 S ONEIDA ST, GREEN BAY, WI 54304-5267
(920) 499-1177
(920) 499-5398

Taxonomy

Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
403-025
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
43217500
WI
Enumeration date
02/12/2008
Last updated
02/12/2008
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