Provider Demographics
NPI:1497753925
Name:GLOWIENKA, PAUL ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:ROBERT
Last Name:GLOWIENKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2510 COMMONS BLVD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45431-3809
Mailing Address - Country:US
Mailing Address - Phone:937-429-0607
Mailing Address - Fax:937-558-3067
Practice Address - Street 1:2510 COMMONS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45431-3809
Practice Address - Country:US
Practice Address - Phone:937-429-0607
Practice Address - Fax:937-558-3067
Is Sole Proprietor?:No
Enumeration Date:2005-07-08
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35081218207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7150402OtherAETNA
OHP00116116OtherRR MEDICARE
OH2376727Medicaid
OH311816166OtherTRICARE
OH311816166027OtherCARESOURCE
OH000000258024OtherANTHEM
OH4100771Medicare PIN
OH311816166OtherTRICARE