Individual
GLEN A. BRUNK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
679 E COUNTY LINE RD, GREENWOOD, IN 46143-1049
(317) 859-7222
(317) 859-7220
Mailing address
679 E COUNTY LINE RD, GREENWOOD, IN 46143-1049
(317) 859-7222
(317) 859-4268
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
01026203A
IN
Other
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
Enumeration date
07/28/2006
Last updated
03/17/2021
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