# GLEN A. BRUNK

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1174537914
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 01026203A | IN | Yes |

## Other

- **Enumeration date:** 07/28/2006
- **Last updated:** 03/17/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 000000091688 | ANTHEM PROVIDER NUMBER | IN |
| 01 | — | 100194370 | MEDICAID GROUP NUMBER | IN |
| 05 | — | 100352480 | — | IN |
| 01 | — | 1487680518 | GROUP NPI \# | — |
| 01 | — | 340012486 | MEDICARE RAILROAD | IN |
| 01 | — | 340012500 | MEDICARE RAILROAD | IN |
| 01 | — | 340012514 | MEDICARE RAILROAD | IN |