Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208200000X | Surgeon | 01046364A | IN |
N | 208600000X | Surgeon | 01046364A | IN |
Y | 208G00000X | Cardiothoracic Vascular Surgeon | 01046364A | IN |
NPI | 1083705842 |
---|---|
Provider Name | Glenn N Carlos |
First Address | Indianapolis, IN 46219-4959 |
Second Address | Indianapolis, IN 46202-1196 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/09/2006 |
Last Update Date | 23/01/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000000834804 | ANTHEM PIN (01) | IN |
200013190 | (05) | IN |
F83574 | (02) |