MEDICARE: STEPHEN H. GLASSLEY M.D.

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	207Q00000X	Family Medicine Physician	01018040A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	080130064	OTHER	IN	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000111940	OTHER	IN	ANTHEM
2	00001076337 05	OTHER		UNITED HEALTHCARE
3	1335	OTHER	IN	PHYSICIANS HEALTH PLAN
5	4047058	OTHER		AETNA
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063497444
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN H. GLASSLEY M.D.

Provider Business Mailing Address
First Line	:	1234 E DUPONT RD
Second Line	:	SUITE 1
City	:	FORT WAYNE
State	:	IN
Zip	:	46825-1545
Country	:	US
Telephone Number	:	260-373-9700
Fax Number	:	260-373-9740

Provider Business Practice Location Address
First Line	:	2710 LAKE AVE
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46805-5412
Country	:	US
Telephone Number	:	260-373-8070
Fax Number	:	260-373-8071

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

Provider Enumeration Date	:	12/08/2005
Last Update Date	:	03/26/2013

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Directions to “ STEPHEN H. GLASSLEY M.D.” Practice Location

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