MEDICARE: DR. GLENNA CAROLYN FRANKE D.O.

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
1	208D00000X	General Practice Physician	29322	MO
2	208D00000X	General Practice Physician	036056844	IL

General Provider Information

NPI Number	:	1629077110
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENNA CAROLYN FRANKE D.O.

Provider Business Mailing Address
First Line	:	3394 MCKELVEY RD
Second Line	:	STE 113
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2531
Country	:	US
Telephone Number	:	314-291-3409
Fax Number	:	314-739-6798

Provider Business Practice Location Address
First Line	:	3394 MCKELVEY RD
Second Line	:	STE 113
City	:	BRIDGETON
State	:	MO
Zip	:	63044-2531
Country	:	US
Telephone Number	:	314-291-3409
Fax Number	:	314-739-6798

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	02/21/2010

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