Individual
GLEN E LEER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
204 W. MAIN STREET, ARCADIA, IN 46030
(317) 984-8811
(888) 634-3182
Mailing address
PO BOX 383, ARCADIA, IN 46030-0383
(317) 984-8811
(317) 984-5862
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02001252A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100319180B
—
IN
01
—
1343052
FIRST HEALTH
IN
01
—
4909800001
MEDICARE DMEPOS
IN
Enumeration date
10/02/2006
Last updated
05/21/2019
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