Healthcare Provider Details

I. General information

NPI: 1457959041
Provider Name (Legal Business Name): LEONARD C GLASS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LILLY CORPORATE CENTER
INDIANAPOLIS IN
46285-0001
US

IV. Provider business mailing address

2150 MULSANNE DR
ZIONSVILLE IN
46077-9081
US

V. Phone/Fax

Practice location:
  • Phone: 317-504-2375
  • Fax:
Mailing address:
  • Phone: 317-504-2375
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberK7160
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number01060509A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: