Healthcare Provider Details

I. General information

NPI: 1215224126
Provider Name (Legal Business Name): OLEG GLIGICH M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 05/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11373 CORTEZ BLVD SUITE 200
BROOKSVILLE FL
34613
US

IV. Provider business mailing address

14690 SPRING HILL DR STE 305
SPRING HILL FL
34609-8102
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-4998
  • Fax: 352-596-6051
Mailing address:
  • Phone: 352-277-5348
  • Fax: 352-606-2857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 131522
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberME 131522
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: