Individual
GLEN H BROOKSHIRE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
600 EAST BLVD, ELKHART, IN 46514-2483
(574) 523-3160
Mailing address
PO BOX 1241, SOUTH BEND, IN 46624-1241
(885) 691-9888
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
02002322
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000197019
ANTHEM
IN
05
—
114315071
—
MI
05
—
200331530
—
IN
01
—
930109846
RAIL ROAD MEDICARE
IN
Enumeration date
07/29/2005
Last updated
04/05/2016
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