Healthcare Provider Details

I. General information

NPI: 1548589054
Provider Name (Legal Business Name): BRETT JON GLAWE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/24/2010
Last Update Date: 04/04/2022
Certification Date: 04/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CONEY ST W SUITE 140
PERHAM MN
56573-2102
US

IV. Provider business mailing address

1000 CONEY ST W SUITE 140
PERHAM MN
56573-2102
US

V. Phone/Fax

Practice location:
  • Phone: 218-347-1200
  • Fax:
Mailing address:
  • Phone: 218-347-1200
  • Fax: 515-241-4080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberR-8867
License Number StateIA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number59132
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: