Individual
GLENN MITRA BATILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5165 MCCARTY LN, LAFAYETTE, IN 47905-8764
(765) 448-8000
(765) 838-4758
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
01059881A
IN
207L00000X
Anesthesiology Physician
036084852
IL
207L00000X
Anesthesiology Physician
15892
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000001664742
ANTHEM PTAN
IN
01
—
1102030385
ANTHEM PTAN
IN
05
—
200811400
—
IN
01
—
Q00773297
RAILROAD PTAN
IN
Enumeration date
02/03/2006
Last updated
12/11/2024
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