Provider Demographics
NPI:1144271404
Name:GLINERT, ROBERT J (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:GLINERT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 SHERMAN AVE E
Mailing Address - Street 2:FORT HEALTHCARE CENTER FOR DERMATOLOGY
Mailing Address - City:FORT ATKINSON
Mailing Address - State:WI
Mailing Address - Zip Code:53538-1960
Mailing Address - Country:US
Mailing Address - Phone:920-568-1000
Mailing Address - Fax:920-568-5477
Practice Address - Street 1:611 SHERMAN AVE E
Practice Address - Street 2:FORT HEALTHCARE CENTER FOR DERMATOLOGY
Practice Address - City:FORT ATKINSON
Practice Address - State:WI
Practice Address - Zip Code:53538-1960
Practice Address - Country:US
Practice Address - Phone:920-568-1000
Practice Address - Fax:920-568-5477
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI31119-020207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI31596800Medicaid
WIBG1974004OtherDEA
WI31596800Medicaid
WI006030345Medicare PIN