Healthcare Provider Details

I. General information

NPI: 1417307745
Provider Name (Legal Business Name): GLENN ENGELMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2016
Last Update Date: 12/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1375 E 19TH AVE
DENVER CO
80218-1114
US

IV. Provider business mailing address

1960 N OGDEN ST STE 400
DENVER CO
80218-3670
US

V. Phone/Fax

Practice location:
  • Phone: 303-812-6400
  • Fax:
Mailing address:
  • Phone: 303-318-1540
  • Fax: 303-318-2481

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License NumberTL 0006339
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number97828
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: