Healthcare Provider Details

I. General information

NPI: 1215151857
Provider Name (Legal Business Name): SCOTT D. GLAZER, M.D., S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 05/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 W LAKE COOK RD STE 110
BUFFALO GROVE IL
60089-2085
US

IV. Provider business mailing address

600 W LAKE COOK RD STE 110
BUFFALO GROVE IL
60089-2085
US

V. Phone/Fax

Practice location:
  • Phone: 847-459-6611
  • Fax: 847-459-6621
Mailing address:
  • Phone: 847-459-6611
  • Fax: 847-459-7929

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036059380
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036073084
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036102194
License Number StateIL
# 4
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number036111358
License Number StateIL
# 5
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number036059380
License Number StateIL
# 6
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number036073084
License Number StateIL
# 7
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number036102194
License Number StateIL
# 8
Primary TaxonomyN
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number036111358
License Number StateIL
# 9
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number036073084
License Number StateIL
# 10
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number036102194
License Number StateIL
# 11
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number036111358
License Number StateIL
# 12
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number036062019
License Number StateIL
# 13
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number036062967
License Number StateIL
# 14
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number036059380
License Number StateIL

VIII. Authorized Official

Name: MRS. JILL A SUTHERLAND
Title or Position: PRACTICE MANAGER
Credential: CPC-D
Phone: 847-459-6495