Healthcare Provider Details

I. General information

NPI: 1336395904
Provider Name (Legal Business Name): CARLOS F SANCHEZ -GLANVILLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: CARLOS F SANCHEZ-GLANVILLE MD

II. Dates (important events)

Enumeration Date: 08/14/2008
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N 9TH ST
SPRINGFIELD IL
62702-5310
US

IV. Provider business mailing address

9300 VALLEY CHILDRENS PL
MADERA CA
93636-8761
US

V. Phone/Fax

Practice location:
  • Phone: 217-545-8000
  • Fax:
Mailing address:
  • Phone: 559-353-5700
  • Fax: 559-353-5708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number036144448
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number18284
License Number StatePR
# 3
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License NumberA157868
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number61083
License Number StateTN
# 5
Primary TaxonomyN
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number18284
License Number StatePR
# 6
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number036144448
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: