Healthcare Provider Details

I. General information

NPI: 1134048663
Provider Name (Legal Business Name): BRIAN THOMAS GLENNIE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 CHRISTIAN ST
ALPENA MI
49707-3008
US

IV. Provider business mailing address

126 CHRISTIAN ST
ALPENA MI
49707-3008
US

V. Phone/Fax

Practice location:
  • Phone: 989-657-9117
  • Fax:
Mailing address:
  • Phone: 989-657-9117
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberG450098792906
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: