| Organization Name: | GLENN F DEVRIES |
| NPI Number: | 1265510564 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | GLENN F DEVRIES (OWNER) |
| Mailing Address: | 680 E Fond Du Lac St Ripon |
| State: | WI US |
| Postal Code: | 549719500 |
| Phone Number: | 9207483009 |
| Fax Number: | 9207483109 |
| NPI Enumeration Date: | 11/02/2006 |
| NPI Last Update Date: | 08/17/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 213ES0103X |
| License Number: | 467 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | WI |
| Taxonomy Type: | Podiatric Medicine & Surgery Service Providers |
| Taxonomy Classification: | Podiatrist |
| Taxonomy Specialization: | Foot & Ankle Surgery |
| Taxonomy Definition: | |