Individual
DR. GLEN B SMITH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1505 EASTLAND DR, SUITE 210, BLOOMINGTON, IL 61701-7906
(309) 662-5506
(309) 662-5443
Mailing address
1505 EASTLAND DR, SUITE 210, BLOOMINGTON, IL 61701-7906
(309) 662-5506
(309) 662-5443
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
036075454
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008131
HEALTH ALLIANCE PROVIDER
IL
01
—
036075454000
OSF HEALTH PLANS
—
01
—
05732036
BLUE SHIELD GROUP NUMBER
IL
01
—
1955270
UNITED HEALTHCARE
—
05
—
205477201
—
MO
01
—
228074
HEALTHLINK
—
01
—
233989
PERSONAL CARE
—
01
—
37773
PHCS
—
01
—
37893
TRICARE
—
01
—
IL0102
JOHN DEERE HEALTH PLAN
—
Enumeration date
08/26/2005
Last updated
11/13/2012
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