Healthcare Provider Details

I. General information

NPI: 1154235414
Provider Name (Legal Business Name): MICHAEL L GLADUE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 HOSPITAL LOOP
BELCOURT ND
58316-7712
US

IV. Provider business mailing address

PO BOX 160
BELCOURT ND
58316-0160
US

V. Phone/Fax

Practice location:
  • Phone: 701-477-6111
  • Fax: 701-477-2500
Mailing address:
  • Phone: 701-477-6111
  • Fax: 701-477-2500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License NumberGLA-67-4448
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: