Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | BP10036778 | TX |
Y | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 036143728 | IL |
NPI | 1427379221 |
---|---|
Provider Name | Dr. Dianne Henry Glass |
First Address | Burr Ridge, IL 60527-5965 |
Second Address | Chicago, IL 60637-1443 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2010 |
Last Update Date | 09/11/2017 |