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General NPI Number Information
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NPI Number | 1033137260
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Entity Type | Individual
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Provider Name | ELLEN GLICK MD
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Gender | Female
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 10/13/2020
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Provider Practice Location Address
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Address Line | 185 MILWAUKEE AVE SUITE 225
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City | LINCOLNSHIRE
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State | IL
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Zip | 60069-3010
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Country | US
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Telephone | 847-634-9805
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Fax |
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Provider Business Mailing Address
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Address Line | 777 OAKMONT LN SUITE 1600
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City | WESTMONT
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State | IL
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Zip | 60559-5511
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Country | US
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Telephone | 630-789-2550
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | 036075019
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License Number State | IL
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