Individual
GLEN E DUST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1000 MEDICAL CENTER DR, MONTICELLO, IL 61856-2116
(217) 762-6241
(217) 762-1702
Mailing address
1000 MEDICAL CENTER DR, MONTICELLO, IL 61856-2116
(217) 762-6241
(217) 762-1702
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036068658
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0007000023
BCBS OF ILLINOIS
IL
05
—
0360686581
—
IL
01
—
080027217
PALMETTO
IL
01
—
182358
HEALTHLINK
IL
Enumeration date
06/01/2005
Last updated
06/21/2023
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