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Individual

DR. KAHLIL S GLENN

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
150 W WASHINGTON ST, SHELBYVILLE, IN 46176-1236
(317) 392-3211
(317) 421-2131
Mailing address
1626 E STATE ROAD 44, SUITE B, SHELBYVILLE, IN 46176-4026
(317) 421-2012
(317) 421-2131

Taxonomy

Speciality
Code
Description
License number
State
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
Primary
01056694
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000392328
ANTHEM BCBS
IN
01
01056694
STATE LICENSE
IN
01
PENDING
RAILROAD MCR
IN
05
PENDING
IN
Enumeration date
07/21/2006
Last updated
02/07/2008
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