MEDICARE: DR. JONATHAN S MCGLOTHAN 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	207W00000X	Ophthalmology Physician	35.124274	OH
2	207W00000X	Ophthalmology Physician	41406	KY
3	207W00000X	Ophthalmology Physician	4301111306	MI
4	207W00000X	Ophthalmology Physician	01043767A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1154374973
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN S MCGLOTHAN M.D.

Provider Business Mailing Address
First Line	:	15273 SLATEFORD RD
Second Line	:
City	:	NOBLESVILLE
State	:	IN
Zip	:	46062-7712
Country	:	US
Telephone Number	:	317-267-9014
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 N WABASH AVE STE P2E
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60611-3591
Country	:	US
Telephone Number	:	312-955-0071
Fax Number	:

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

Provider Enumeration Date	:	05/19/2006
Last Update Date	:	06/12/2019

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Directions to “ DR. JONATHAN S MCGLOTHAN M.D.” Practice Location

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