MEDICARE: CENTER FOR NEUROSURGERY(GLICKMAN) PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207T00000X	Neurological Surgery Physician

General Provider Information

NPI Number	:	1144849738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR NEUROSURGERY(GLICKMAN) PLLC

Provider Business Mailing Address
First Line	:	42 BUSINESS CENTRE DR UNIT 310
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-6995
Country	:	US
Telephone Number	:	850-803-2672
Fax Number	:	850-600-2675

Provider Business Practice Location Address
First Line	:	42 BUSINESS CENTRE DR UNIT 310
Second Line	:
City	:	MIRAMAR BEACH
State	:	FL
Zip	:	32550-6995
Country	:	US
Telephone Number	:	850-803-2672
Fax Number	:	850-600-2675

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	SCOTT GARY GLICKMAN
Credential	:
Telephone Number	:	850-803-2672

Provider Enumeration Date	:	04/13/2020
Last Update Date	:	03/19/2024

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