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NPI Code Detail

MEDICARE: DR. GLENN IMMANUEL KOLLURI ME87511

MEDICARE: DR. GLENN IMMANUEL KOLLURI ME87511
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
12084N0400XNeurology PhysicianME87511FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1780622480
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. GLENN IMMANUEL KOLLURI ME87511
Provider Business Mailing Address
First Line : PO BOX 417
Second Line :
City : STUART
State : FL
Zip : 34995-0417
Country : US
Telephone Number : 772-223-5665
Fax Number : 772-223-5646
Provider Business Practice Location Address
First Line : 200 SE HOSPITAL AVE
Second Line :
City : STUART
State : FL
Zip : 34994-2346
Country : US
Telephone Number : 772-223-5618
Fax Number : 772-223-5646
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/03/2006
Last Update Date : 03/08/2026

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