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General NPI Number Information
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NPI Number | 1497099113
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Entity Type | Organization
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Legal Business Name | SCOTT D, GLAZER, M.D., S.C.
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Dates
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Enumeration Date | 11/19/2012
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Last Update Date | 08/20/2013
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Provider Practice Location Address
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Address Line | 767 PARK AVE W SUITE 310
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2400
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Country | US
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Telephone | 847-432-4650
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Fax | 847-480-2616
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Provider Business Mailing Address
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Address Line | 767 PARK AVE W STE 310
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City | HIGHLAND PARK
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State | IL
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Zip | 60035-2400
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Country | US
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Telephone | 847-432-4650
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Fax | 847-459-7929
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JILL SUTHERLAND
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Credential | CPC-D, MA
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Telephone | 847-432-4650
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 036062019
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 036073084
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License Number State | IL
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Taxonomy #3
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 036102194
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License Number State | IL
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Taxonomy #4
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 036111358
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License Number State | IL
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Taxonomy #5
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Taxonomy Code | 207NS0135X
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Taxonomy Name | Procedural Dermatology Physician
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License Number | 036059380
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License Number State | IL
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