Healthcare Provider Details

I. General information

NPI: 1689629750
Provider Name (Legal Business Name): JOHN C GLASPEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 N 51ST ST #P309
MILWAUKEE WI
53210-1645
US

IV. Provider business mailing address

3070 N 51 ST #P309
MILWAUKEE WI
53210
US

V. Phone/Fax

Practice location:
  • Phone: 414-447-2663
  • Fax: 414-447-2884
Mailing address:
  • Phone: 414-447-2663
  • Fax: 414-447-2884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number18681
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: