Individual
GLEN T. HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226
(414) 805-3750
(414) 259-9290
Mailing address
9200 W WISCONSIN AVE, MILWAUKEE, WI 53226-3522
(414) 805-3750
(414) 259-9290
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
35-082795
OH
2085R0202X
Diagnostic Radiology Physician
35082795
OH
2085R0202X
Diagnostic Radiology Physician
Primary
66674
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1679754675
—
WI
05
—
2839101
—
OH
01
—
P00620399
RAILROAD MEDICARE
OH
Enumeration date
11/18/2007
Last updated
10/30/2019
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