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NPI Code Detail

MEDICARE: GLENN STEPHEN COATS M.D.

MEDICARE: GLENN STEPHEN COATS 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
12085R0202XDiagnostic Radiology Physician01076627AIN

Other Identifiers

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

General Provider Information

NPI Number : 1215220363
Entity Type Code : Individual
Provider Name (Legal Business Name) : GLENN STEPHEN COATS M.D.
Provider Business Mailing Address
First Line : PO BOX 749495
Second Line :
City : ATLANTA
State : GA
Zip : 30374-9495
Country : US
Telephone Number : 855-963-2100
Fax Number : 239-236-2775
Provider Business Practice Location Address
First Line : 7910 W JEFFERSON BLVD STE 108
Second Line :
City : FORT WAYNE
State : IN
Zip : 46804-4159
Country : US
Telephone Number : 260-436-0800
Fax Number : 260-483-1911
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2011
Last Update Date : 03/31/2026

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Directions to “ GLENN STEPHEN COATS M.D.” Practice Location

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