1992815377 NPI number — MICHAEL D GLANT MD

Table of content: MICHAEL D GLANT MD (NPI 1992815377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992815377 NPI number — MICHAEL D GLANT MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLANT
Provider First Name:
MICHAEL
Provider Middle Name:
D
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1992815377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9550 ZIONSVILLE RD
Provider Second Line Business Mailing Address:
SUITE #200
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46268-1065
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-872-0116
Provider Business Mailing Address Fax Number:
317-874-1440

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9550 ZIONSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE #200
Provider Business Practice Location Address City Name:
INDIANAPOLIS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46268-1065
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-872-0116
Provider Business Practice Location Address Fax Number:
317-874-1440
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZC0500X , with the licence number:  NA , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 01026522 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 036099561 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: 01026522 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 5811655 . This is a "AETNA PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100037900 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1992815377 . This is a "BCBS-MO" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 5601593 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 100237180 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1100097 . This is a "UHC MEDICARE COMPLETE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 110884 . This is a "INDIANA COMPREHENSIVE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 1194840595 . This is a "ANTHEM-IN" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 110884 . This is a "ANTHEM BLUE SHIELD" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
  • Identifier: 2060835 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: B29555 . This is a "MERCY HEALTH PLAN HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 238490 . This is a "HARMONY HEALTH" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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