Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QG0300X | Family Doctor - Geriatric Medicine | 036057005 | IL |
NPI | 1124136601 |
---|---|
Provider Name | Melvin I Glick |
First Address | Western Springs, IL 60558-1283 |
Second Address | Western Springs, IL 60558-1283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2006 |
Last Update Date | 29/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
036057005 | (05) | IL |
080162189 | RR MED (01) | IL |
21628146 | BCBS (01) | IL |
570740 | MEDICARE GROUP (01) | IL |
D13788 | (02) |