Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RI0200X | Infectious Disease | 036075019 | IL |
NPI | 1033137260 |
---|---|
Provider Name | Ellen Glick |
First Address | Westmont, IL 60559-5511 |
Second Address | Lincolnshire, IL 60069-3010 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/07/2006 |
Last Update Date | 13/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C45210 | (02) | IL |