MEDICARE: WALTER PAUL GLEICH M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	26841	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205823440
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER PAUL GLEICH M.D.

Provider Business Mailing Address
First Line	:	2550 UNIVERSITY AVE W
Second Line	:	SUITE 240N
City	:	SAINT PAUL
State	:	MN
Zip	:	55114-1052
Country	:	US
Telephone Number	:	651-999-6909
Fax Number	:	651-297-6115

Provider Business Practice Location Address
First Line	:	360 SHERMAN ST
Second Line	:	SUITE 450
City	:	SAINT PAUL
State	:	MN
Zip	:	55102-2564
Country	:	US
Telephone Number	:	651-999-6800
Fax Number	:	651-999-6808

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/03/2005
Last Update Date	:	10/25/2012

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