Healthcare Provider Details

I. General information

NPI: 1508819442
Provider Name (Legal Business Name): MR. GLENN S. FRONHEISER
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 VETERANS DR
MINNEAPOLIS MN
55417-2309
US

IV. Provider business mailing address

7244 MONARDO LN
EDINA MN
55435-4010
US

V. Phone/Fax

Practice location:
  • Phone: 612-467-4087
  • Fax: 612-725-2245
Mailing address:
  • Phone: 612-467-4087
  • Fax: 612-725-2245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number948
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: