MEDICARE: GLENN ALAN GLOGAS MD

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	01044148	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	:	1346221165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN ALAN GLOGAS MD

Provider Business Mailing Address
First Line	:	11109 PARKVIEW PLAZA DR # 117
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46845-1701
Country	:	US
Telephone Number	:	260-266-8210
Fax Number	:

Provider Business Practice Location Address
First Line	:	1316 E 7TH ST
Second Line	:	SECOND FLOOR
City	:	AUBURN
State	:	IN
Zip	:	46706-2538
Country	:	US
Telephone Number	:	260-424-9000
Fax Number	:	260-425-3029

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	10/07/2022

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