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

Table of Contents

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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