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1215329958 NPI number — PETER ANDREW GLYNN MD

NPI Number: 1215329958
Health Care Provider/Practitioner: PETER ANDREW GLYNN MD

Information about “1215329958” NPI (PETER ANDREW GLYNN MD) exists in 1215329958 in HTML format HTML  |  1215329958 in plain Text format TXT  |  1215329958 in PDF (Portable Document Format) PDF  |  1215329958 in an XML format XML  formats.

NPI Number : 1215329958 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1215329958",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GLYNN",
    "FirstName": "PETER",
    "MiddleName": "ANDREW",
    "NamePrefix": "MR.",
    "NameSuffix": null,
    "Credential": "MD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "840 S WOOD ST STE 920S",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "CHICAGO",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60612-4325",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "312-996-6730",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "1740 W TAYLOR ST",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "CHICAGO",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60612-7232",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "866-600-2273",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "03/03/2015",
    "LastUpdateDate": "08/07/2024",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "207R00000X",
          "TaxonomyName": "Internal Medicine Physician",
          "LicenseNumber": "036151132",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "390200000X",
          "TaxonomyName": "Student in an Organized Health Care Education/Training Program",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "207RC0000X",
          "TaxonomyName": "Cardiovascular Disease Physician",
          "LicenseNumber": "036151132",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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