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General NPI Number Information
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NPI Number | 1275775553
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Entity Type | Organization
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Legal Business Name | JEFFREY J GLASS MDSC
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Dates
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Enumeration Date | 04/01/2009
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Last Update Date | 04/01/2009
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Provider Practice Location Address
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Address Line | 1160 PARK AVE W SUITE 3N
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2230
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Country | US
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Telephone | 847-433-6990
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Fax | 847-433-8738
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Provider Business Mailing Address
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Address Line | 1160 PARK AVE W SUITE 3N
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2230
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Country | US
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Telephone | 847-433-6990
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Fax | 847-433-8738
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JEFFREY J GLASS
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Credential | MD
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Telephone | 847-433-6990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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