Individual
DR. GLENN RICHARD OLDS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
FROEDTERT & MED COLLEGE CLIN - EAST, 9200 WEST WISCONSIN AVENUE, MILWAUKEE, WI 53226
(414) 805-3666
Mailing address
9200 W WISCONSIN AVE, FROEDTERT & MED COLLEGE CLIN - EAST, MILWAUKEE, WI 53226-3522
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
42878
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
003006261R
HUMANA
—
05
—
34047100
—
WI
Enumeration date
05/17/2006
Last updated
07/14/2009
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