MEDICARE: GLENN J. BINGLE M.D., PH.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	207R00000X	Internal Medicine Physician	01023822A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000000764647	OTHER	IN	ANTHEM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568456150
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GLENN J. BINGLE M.D., PH.D.

Provider Business Mailing Address
First Line	:	8141 BOUNTY CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-8941
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8141 BOUNTY CT
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46236-8941
Country	:	US
Telephone Number	:	317-823-7495
Fax Number	:

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

Provider Enumeration Date	:	09/09/2005
Last Update Date	:	01/30/2024

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