Healthcare Provider Details

I. General information

NPI: 1265514731
Provider Name (Legal Business Name): GLENN ROBERT MEINTS DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

324 W SUPERIOR ST STE 517
DULUTH MN
55802-1760
US

IV. Provider business mailing address

2107 E 4TH ST
DULUTH MN
55812-1427
US

V. Phone/Fax

Practice location:
  • Phone: 218-722-0326
  • Fax: 218-722-4403
Mailing address:
  • Phone: 218-724-9581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License Number532
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: