IndividualActive
Glen Booth, M.D.
NPI 1083740393 · General Practice Physician · Minneapolis, MN
Provider details
- NPI number
- 1083740393
- Entity type
- Individual
- Primary specialty
- General Practice PhysicianAllopathic & Osteopathic Physicians
- Credential
- M.D.
- Sex
- Male
- Sole proprietor
- No
- License
- B29991 (MN)
Specialties & taxonomies
Allopathic & Osteopathic Physicians
Practice location
1089 25th Ave Se
Minneapolis, MN 55414-2637
Phone: (612) 379-0212
Approximate (ZIP-level) locationGet directions
Mailing address
1089 25th Ave Se
Minneapolis, MN 55414-2637
Registry dates
- Enumerated
- 2007-02-23
- Last updated
- 2026-05-24
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.