MEDICARE: DR. GLEN S BABICH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	036-114518	IL
2	208D00000X	General Practice Physician	47521	AZ
3	208D00000X	General Practice Physician	E-6244	AR
4	208D00000X	General Practice Physician	M-9700	ID
5	208D00000X	General Practice Physician	01077201A	IN
6	208D00000X	General Practice Physician	04-37037	KS
7	208D00000X	General Practice Physician	MD0000027058	TN
8	208D00000X	General Practice Physician	MD2002010249	MO

General Provider Information

NPI Number	:	1184617086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN S BABICH MD

Provider Business Mailing Address
First Line	:	813 STONE CREEK LN
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-2655
Country	:	US
Telephone Number	:	615-973-0026
Fax Number	:	618-213-7168

Provider Business Practice Location Address
First Line	:	813 STONE CREEK LN
Second Line	:
City	:	BELLEVILLE
State	:	IL
Zip	:	62223-2655
Country	:	US
Telephone Number	:	615-973-0026
Fax Number	:	618-213-7168

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	06/25/2020

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Directions to “ DR. GLEN S BABICH MD” Practice Location

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