Healthcare Provider Details

I. General information

NPI: 1124055736
Provider Name (Legal Business Name): MICHAEL GLASSMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 06/02/2020
Certification Date: 06/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S PARK RD STE 300
HOLLYWOOD FL
33021-8353
US

IV. Provider business mailing address

300 S PARK RD STE 300
HOLLYWOOD FL
33021-8353
US

V. Phone/Fax

Practice location:
  • Phone: 954-925-2740
  • Fax: 954-923-8379
Mailing address:
  • Phone: 954-925-2740
  • Fax: 954-923-8379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number213076-1
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME79140
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: