Healthcare Provider Details

I. General information

NPI: 1760781363
Provider Name (Legal Business Name): KATHLEEN GLOVER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/22/2011
Last Update Date: 03/28/2024
Certification Date: 03/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 CREEKWOOD CT
SPRINGFIELD OH
45504-4056
US

IV. Provider business mailing address

2530 SUTTON RD
YELLOW SPRINGS OH
45387-8744
US

V. Phone/Fax

Practice location:
  • Phone: 937-320-0922
  • Fax:
Mailing address:
  • Phone: 937-416-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35.059888
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number35.059888
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number35-059888
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: