Provider Demographics
NPI:1992815377
Name:GLANT, MICHAEL D (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:D
Last Name:GLANT
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:9550 ZIONSVILLE RD
Mailing Address - Street 2:SUITE #200
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46268-1065
Mailing Address - Country:US
Mailing Address - Phone:317-872-0116
Mailing Address - Fax:317-874-1440
Practice Address - Street 1:9550 ZIONSVILLE RD
Practice Address - Street 2:SUITE #200
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46268-1065
Practice Address - Country:US
Practice Address - Phone:317-872-0116
Practice Address - Fax:317-874-1440
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2009-06-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
INNA207ZC0500X
IN01026522208D00000X, 207ZP0102X
IL036099561208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
5811655OtherAETNA PPO
KY7100037900Medicaid
MO1992815377OtherBCBS-MO
5601593OtherAETNA HMO
IN100237180Medicaid
1100097OtherUHC MEDICARE COMPLETE
IN110884OtherINDIANA COMPREHENSIVE
IN1194840595OtherANTHEM-IN
IN110884OtherANTHEM BLUE SHIELD
OH2060835Medicaid
B29555OtherMERCY HEALTH PLAN HMO
IL238490OtherHARMONY HEALTH
5601593OtherAETNA HMO
IN110884OtherINDIANA COMPREHENSIVE
INB29555Medicare UPIN
5811655OtherAETNA PPO