Healthcare Provider Details

I. General information

NPI: 1548255078
Provider Name (Legal Business Name): KENNETH P GLASSMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 01/13/2023
Certification Date: 01/13/2023
Deactivation Date: 08/23/2022
Reactivation Date: 01/13/2023

III. Provider practice location address

200 SPRUCE ST 100
DENVER CO
80230-7126
US

IV. Provider business mailing address

200 SPRUCE ST 100
DENVER CO
80230-7126
US

V. Phone/Fax

Practice location:
  • Phone: 303-394-2828
  • Fax: 303-320-0242
Mailing address:
  • Phone: 303-394-2828
  • Fax: 303-320-0242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number25891
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number25891
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: