Dr. Glen Joseph Booth , MD
General Practice • Minneapolis, MN
Notice of NPI Deactivation & Inactive Practice Status
According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Glen Booth has officially deactivated this NPI record and ceased active healthcare practice.
Professional Overview & Biography Verified Profile Summary
Dr. Glen Booth, MD was a registered General Practice practicing in Minneapolis, MN. Throughout an active medical career spanning 19 years, Dr. Booth provided care at the practice location at 1089 25TH AVE SE until profile deactivation on 2026-07-09.
Practice Location & Contact Primary Location
1089 25th Ave Se
Minneapolis, MN 554142637
Specialty Benchmarks & Practice Insights
Comparative analytics for General Practice in Minneapolis, MN
Practicing in Minneapolis, MN (95 Statewide)
In-Person Office Visits Only
Under CMS Medicare Fee Schedule vs Standard Submitted Charges
Medical Specialties & State Licenses
NUCC Taxonomy Code: 208D00000X
A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
Career & Practice History Timeline
Chronological log of verified NPI updates, location relocations, credentials, and registry changes
Record deactivated on July 09, 2026
NPI status registered as active in NPPES database
Registered at 1089 25TH AVE SE, MINNEAPOLIS, MN 554142637 (Tel: 6123790212)
Registered at 1089 25TH AVE SE, MINNEAPOLIS, MN 554142637 (Tel: 6123790212)
Recorded as GLEN BOOTH, M.D.
General Practice (License #B29991 in MN)
First registered as active Individual Practitioner in NPPES Database.
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NPI Administrative Meta
Mailing Address
1089 25th Ave Se
Minneapolis, MN 554142637
Phone: 6123790212
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