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NPI Code Detail

MEDICARE: DR. GLENN MICHAEL WEINRAUB DPM

MEDICARE: DR. GLENN MICHAEL WEINRAUB DPM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1213EP1101XPrimary Podiatric Medicine PodiatristE4043CA
2213ES0103XFoot & Ankle Surgery PodiatristE4043CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093786998
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GLENN MICHAEL WEINRAUB DPM
Provider Business Mailing Address
First Line : 2500 MERCED ST
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94577-4201
Country : US
Telephone Number : 510-454-1000
Fax Number : 540-772-3785
Provider Business Practice Location Address
First Line : 2500 MERCED ST
Second Line :
City : SAN LEANDRO
State : CA
Zip : 94577-4201
Country : US
Telephone Number : 510-454-1000
Fax Number : 540-772-3785
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2006
Last Update Date : 01/04/2022

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