MEDICARE: DR. PAUL ROBERT GLOWIENKA 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	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	35081218	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	P00116116	OTHER	OH	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	7150402	OTHER	OH	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	311816166	OTHER	OH	TRICARE
5	311816166027	OTHER	OH	CARESOURCE
6	000000258024	OTHER	OH	ANTHEM

General Provider Information

NPI Number	:	1497753925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAUL ROBERT GLOWIENKA M.D.

Provider Business Mailing Address
First Line	:	2510 COMMONS BLVD
Second Line	:	SUITE 210
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-3809
Country	:	US
Telephone Number	:	937-429-0607
Fax Number	:	937-558-3067

Provider Business Practice Location Address
First Line	:	2510 COMMONS BLVD
Second Line	:	SUITE 210
City	:	BEAVERCREEK
State	:	OH
Zip	:	45431-3809
Country	:	US
Telephone Number	:	937-429-0607
Fax Number	:	937-558-3067

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	02/14/2014

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Directions to “ DR. PAUL ROBERT GLOWIENKA M.D.” Practice Location

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