MEDICARE: DR. GLEN DAVID SOLOMON MD

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	207R00000X	Internal Medicine Physician	036066707	IL
2	2084N0400X	Neurology Physician	86292	WI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760481626
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN DAVID SOLOMON MD

Provider Business Mailing Address
First Line	:	9200 W WISCONSIN AVE
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53226-3522
Country	:	US
Telephone Number	:	414-805-5200
Fax Number	:	414-259-0469

Provider Business Practice Location Address
First Line	:	1222 S PATTERSON BLVD
Second Line	:	SUITE 230
City	:	DAYTON
State	:	OH
Zip	:	45402-2684
Country	:	US
Telephone Number	:	937-223-5350
Fax Number	:	937-224-3112

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/21/2005
Last Update Date	:	09/10/2025

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Directions to “ DR. GLEN DAVID SOLOMON MD” Practice Location

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