National Provider Identifier Database

GLENN R GOURLEY, MD – NPI #1689606287
Pediatric Gastroenterology

A pediatrician who specializes in the diagnosis and treatment of diseases of the digestive systems of infants, children and adolescents. This specialist treats conditions such as abdominal pain, ulcers, diarrhea, cancer and jaundice and performs complex diagnostic and therapeutic procedures using lighted scopes to see internal organs.


Contact Information

GLENN R GOURLEY, MD
3001 BROADWAY ST NE STE 500
MINNEAPOLIS, MN55413-2197
Phone: 612-871-1145
Fax: 612-870-5491
Website:
Specialty Taxonomy Code
* Pediatric Gastroenterology 2080P0206X
Pediatrics 208000000X

* Indicates primary specialty

NPI Profile & details for GLENN R GOURLEY

NPI Number 1689606287
Credentials MD
Entity Individual
Enumeration date 07/06/2006
Last updated 06/05/2019 - About 7 years ago
Sole proprietor1 No
Identifiers
  • AR License #: E-10741
  • MN License #: 48367
  • IA Medicaid: 1511089
  • MN Medicaid: 220820200
  • MN Other: 730T5GO BCBS
  • MN Other: 29-00053 MEDICA CHOICE
  • MN Other: 29-00477 MEDICA CHOICE
  • MN Other: 29-00053 MEDICA PRIMARY
  • MN Other: 1046326 PREFERRED ONE
  • MN Other: 182562 UCARE
Hospital affiliation n/a

1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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