Individual
GLEN T. HANSEN
Active
Individual
GLEN T. HANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
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
Update your record
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