Provider Demographics
NPI:1447255161
Name:GLAWE, DENNIS D (DO)
Entity type:Individual
Prefix:
First Name:DENNIS
Middle Name:D
Last Name:GLAWE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1836 SOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CROSSE
Mailing Address - State:WI
Mailing Address - Zip Code:54601-5429
Mailing Address - Country:US
Mailing Address - Phone:608-782-7300
Mailing Address - Fax:
Practice Address - Street 1:101 N MARYVILLE ST
Practice Address - Street 2:
Practice Address - City:CALMAR
Practice Address - State:IA
Practice Address - Zip Code:52132-8521
Practice Address - Country:US
Practice Address - Phone:563-562-3211
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-17
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI26655207Q00000X
IA1861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA55876Medicare PIN
B18018Medicare UPIN