Individual
STEPHEN H. GLASSLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2710 LAKE AVE, FORT WAYNE, IN 46805-5412
(260) 373-8070
(260) 373-8071
Mailing address
1234 E DUPONT RD, SUITE 1, FORT WAYNE, IN 46825-1545
(260) 373-9700
(260) 373-9740
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01018040A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000111940
ANTHEM
IN
01
—
00001076337 05
UNITED HEALTHCARE
—
01
—
080130064
RAILROAD MEDICARE
IN
05
—
100048970
—
IN
01
—
1335
PHYSICIANS HEALTH PLAN
IN
01
—
4047058
AETNA
—
Enumeration date
12/08/2005
Last updated
03/26/2013
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