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NPI 1699871673

NPI 1699871673 : GLENN A. HENNING DPM : HARTFORD, KY

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General NPI Number Information
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    NPI Number           |    1699871673
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    Entity Type          |    Individual 
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    Provider Name        |    GLENN A. HENNING DPM
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    Gender               |    Male 
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Dates
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    Enumeration Date     |    09/16/2006
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    Last Update Date     |    10/22/2024
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Provider Practice Location Address
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    Address Line         |    1215 OLD MAIN ST 
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    City                 |    HARTFORD
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    State                |    KY
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    Zip                  |    42347-1619
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    Country              |    US
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    Telephone            |    270-730-5344
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    Fax                  |    270-298-9506
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Provider Business Mailing Address
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    Address Line         |    PO BOX 148 
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    City                 |    HARTFORD
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    State                |    KY
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    Zip                  |    42347-0148
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    Country              |    US
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    Telephone            |    270-504-1910
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    Fax                  |    270-298-3824
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Authorized Official
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    Title or Position    |    
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    Name                 |        
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    Credential           |    
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    Telephone            |    
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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    Taxonomy Code        |    213ES0103X
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    Taxonomy Name        |    Foot & Ankle Surgery Podiatrist
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    License Number       |    00263
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    License Number State |    KY
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