Provider Demographics
NPI:1699871673
Name:HENNING, GLENN A (DPM)
Entity type:Individual
Prefix:
First Name:GLENN
Middle Name:A
Last Name:HENNING
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 148
Mailing Address - Street 2:
Mailing Address - City:HARTFORD
Mailing Address - State:KY
Mailing Address - Zip Code:42347-0148
Mailing Address - Country:US
Mailing Address - Phone:270-504-1910
Mailing Address - Fax:270-298-3824
Practice Address - Street 1:1215 OLD MAIN ST
Practice Address - Street 2:
Practice Address - City:HARTFORD
Practice Address - State:KY
Practice Address - Zip Code:42347-1619
Practice Address - Country:US
Practice Address - Phone:270-730-5344
Practice Address - Fax:270-298-9506
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2024-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00263213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00263OtherLICENSE
000000198311OtherBCBS PROVIDER NUMBER
KY80000136Medicaid
000000198311OtherBCBS PROVIDER NUMBER
U85747Medicare UPIN
KY480032232Medicare PIN
0570284Medicare PIN
0661944Medicare PIN
KY0601463Medicare PIN
KY00263OtherLICENSE