1497099113 NPI number — SCOTT D, GLAZER, M.D., S.C.

Table of content: (NPI 1497099113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497099113 NPI number — SCOTT D, GLAZER, M.D., S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOTT D, GLAZER, M.D., S.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DERMATOLOGY ASSOCIATES OF HIGHLAND PARK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497099113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
767 PARK AVE W
Provider Second Line Business Mailing Address:
STE 310
Provider Business Mailing Address City Name:
HIGHLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60035-2400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-432-4650
Provider Business Mailing Address Fax Number:
847-459-7929

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
767 PARK AVE W
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
HIGHLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60035-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-432-4650
Provider Business Practice Location Address Fax Number:
847-480-2616
Provider Enumeration Date:
11/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SUTHERLAND
Authorized Official First Name:
JILL
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
847-432-4650

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  036062019 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NS0135X , with the licence number: 036059380 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207NS0135X , with the licence number: 036073084 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NS0135X , with the licence number: 036102194 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207NS0135X , with the licence number: 036111358 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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