Individual
MR. GLEN MICHAEL DIMICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CMD
Contact information
Practice address
3734 W DENISE DR, BLOOMINGTON, IN 47404-8412
(773) 206-0331
Mailing address
3734 W DENISE DR, BLOOMINGTON, IN 47404-8412
Taxonomy
Speciality
Code
Description
License number
State
2085R0001X
Radiation Oncology Physician
Primary
2002093
IN
Other
Enumeration date
11/30/2020
Last updated
11/30/2020
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