1598995870 NPI number — DR. SHARI BETH GLYNN D.O.

Table of content: DR. SHARI BETH GLYNN D.O. (NPI 1598995870)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598995870 NPI number — DR. SHARI BETH GLYNN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GLYNN
Provider First Name:
SHARI
Provider Middle Name:
BETH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1598995870
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 ABBOTT PARK ROAD
Provider Second Line Business Mailing Address:
C/O ABBOTT LABORATORIES: AP6D/DEPT. 058P
Provider Business Mailing Address City Name:
ABBOTT PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60064-6035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-937-7043
Provider Business Mailing Address Fax Number:
847-937-1313

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ABBOTT PARK ROAD
Provider Second Line Business Practice Location Address:
C/O ABBOTT LABORATORIES: AP6D/DEPT. 058P
Provider Business Practice Location Address City Name:
ABBOTT PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60064-6035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-937-7043
Provider Business Practice Location Address Fax Number:
847-937-1313
Provider Enumeration Date:
07/21/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2083P0500X , with the licence number:  036083768 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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