Healthcare Provider Details

I. General information

NPI: 1083607881
Provider Name (Legal Business Name): NANCY R GLICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S CALIFORNIA AVE
CHICAGO IL
60608-1732
US

IV. Provider business mailing address

2236 LINCOLNWOOD DR
EVANSTON IL
60201-2020
US

V. Phone/Fax

Practice location:
  • Phone: 773-257-5442
  • Fax:
Mailing address:
  • Phone: 847-733-9970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: