Healthcare Provider Details

I. General information

NPI: 1982347191
Provider Name (Legal Business Name): GLORIA B DEUTSCH DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2022
Last Update Date: 07/30/2022
Certification Date: 07/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

613 W PARK AVE APT B
LIBERTYVILLE IL
60048-2661
US

IV. Provider business mailing address

111 MACDADE BLVD APT A10
FOLSOM PA
19033-2917
US

V. Phone/Fax

Practice location:
  • Phone: 630-391-3447
  • Fax:
Mailing address:
  • Phone: 630-391-3447
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberSC007303
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: