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Contact Information

GLEN M DIMICK, CMD
3734 W DENISE DR
BLOOMINGTON, IN47404-8412
 Phone: 773-206-0331
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Radiation Oncology

2085R0001X 92 Physician/Radiation Oncology
Indicates primary specialty

NPI Profile & details for GLEN M DIMICK · (Male)

NPI Number 1689278640
Status Active
Credentials CMD
Entity Individual
Enumeration date 11/30/2020
Last updated 11/30/2020 - About 6 years ago
Sole proprietor 1 No
Identifiers
  • IN License # 2002093
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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