MEDICARE: DR. ILANA CARLA GLICK AU.D.

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	231H00000X	Audiologist	AY1676	FL

General Provider Information

NPI Number	:	1881988269
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ILANA CARLA GLICK AU.D.

Provider Business Mailing Address
First Line	:	14020 N 46TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-5778
Country	:	US
Telephone Number	:	813-972-2000
Fax Number	:

Provider Business Practice Location Address
First Line	:	14020 N 46TH ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33613-4018
Country	:	US
Telephone Number	:	813-972-2000
Fax Number	:

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

Provider Enumeration Date	:	06/03/2011
Last Update Date	:	05/07/2012

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