Healthcare Provider Details

I. General information

NPI: 1649204645
Provider Name (Legal Business Name): JUDY LYNN FRUEHBRODT-GLENZINSKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JUDY LYNN FRUEHBRODT

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/07/2021
Certification Date: 01/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 STATE AVE
FARIBAULT MN
55021
US

IV. Provider business mailing address

300 STATE AVE
FARIBAULT MN
55021-6319
US

V. Phone/Fax

Practice location:
  • Phone: 507-333-3300
  • Fax: 507-333-3214
Mailing address:
  • Phone: 507-333-3300
  • Fax: 507-333-3214

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number41619
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: