Mathis, John Glenn

Mathis, John Glenn is an individual health care provider with primary practice located at 17501 Generations Dr , South Bend IN 46635-1589. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Mathis, John Glenn can be contacted via phone (574) 234-0049.

Contact Information

Primary practice address
17501 Generations Dr South Bend IN 46635-1589
Phone: (574) 234-0049
Fax: (574) 251-2861
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Gastroenterology 207RG0100X 01026543A Indiana

Profile Details

NPI number 1427051341
LBN Legal business name Mathis, John Glenn
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date May 24th, 2005
Last updated Oct 4th, 2010 - about 14 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1427051341 NPPES
Indiana Other 4359074 AETNA
Indiana Other 000000084425 AETNA
Indiana MEDICAID 100223380A AETNA
Indiana Other 2010421004 AETNA
Indiana Other 110082368 AETNA

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