Individual
MR. BRYAN JEREMY GLAENZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
530 S JACKSON ST # C07, LOUISVILLE, KY 40202
(502) 852-5875
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
(502) 588-0330
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
125064539
IL
2085R0202X
Diagnostic Radiology Physician
TP484
KY
2085R0204X
Vascular & Interventional Radiology Physician
Primary
52672
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100601240
—
KY
01
—
K303440
MEDICARE
KY
Enumeration date
04/10/2013
Last updated
06/27/2019
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