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NPI Code Detail

MEDICARE: PGP FAMILY PHYSICIANS, LLC

MEDICARE: PGP FAMILY PHYSICIANS, LLC
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1144201971
Entity Type Code : Organization
Provider Name (Legal Business Name) : PGP FAMILY PHYSICIANS, LLC
Provider Business Mailing Address
First Line : 8607 TEMPLE DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46809-3048
Country : US
Telephone Number : 260-478-9220
Fax Number : 260-478-9172
Provider Business Practice Location Address
First Line : 8607 TEMPLE DR
Second Line :
City : FORT WAYNE
State : IN
Zip : 46809-3048
Country : US
Telephone Number : 260-478-9220
Fax Number : 260-478-9172
Authorized Official
Title or Position : PRESIDENT
Name : DR. GLENN ALAN GLOGAS
Credential : M.D.
Telephone Number : 206-478-9220
Provider Enumeration Date : 11/09/2005
Last Update Date : 08/22/2020

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Directions to “PGP FAMILY PHYSICIANS, LLC ” Practice Location

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