Healthcare Provider Details

I. General information

NPI: 1619947157
Provider Name (Legal Business Name): WILLIAM S GLICKFIELD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2006
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3590 BUSENBARK RD STE 400
TRENTON OH
45067-9602
US

IV. Provider business mailing address

3170 KETTERING BLVD BUILDING B 3RD FLOOR
MORAINE OH
45439-1924
US

V. Phone/Fax

Practice location:
  • Phone: 513-988-9243
  • Fax: 513-988-9369
Mailing address:
  • Phone: 937-991-3188
  • Fax: 937-223-9811

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35047466
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: