| Doctor Name: | DR. GLEN S BABICH |
| NPI Number: | 1184617086 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | MD2002010249 |
| Business Practice Address: | 300 E Pedro Simmons Dr Charleston, MO - 638341347 |
| Business Phone Number: | 5736834409 |
| Business Fax Number: | 5736837631 |
| Mailing Address: | 941 E Malone Ave, # 218 SIKESTON |
| State: | MO |
| Postal Code: | 638013213 |
| Phone Number: | 5737031365 |
| Fax Number: | 5734720799 |
| NPI Enumeration Date: | 08/25/2005 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | MD2002010249 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |