Individual
DR. GLENN SCOTT WHEET
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
900 LINCOLN WAY W, MISHAWAKA, IN 46544-1716
(574) 259-6937
(574) 259-6939
Mailing address
900 LINCOLN WAY W, MISHAWAKA, IN 46544-1716
(574) 259-6937
(574) 259-6939
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01048975A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000350460
ANTHEM BCBS OFFICE (CORP)
—
01
—
000000350462
ANTHEM BCBS PROVIDER #
—
01
—
18977
PHPNI PROVIDER #
—
01
—
9364871
PHCS PROVIDER #
—
Enumeration date
01/30/2007
Last updated
07/09/2007
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