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General NPI Number Information
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NPI Number | 1689825119
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Entity Type | Individual
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Provider Name | EITAN PODGAETZ GLIKSBERG MD
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Gender | Male
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Dates
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Enumeration Date | 10/02/2008
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Last Update Date | 04/08/2022
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Provider Practice Location Address
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Address Line | 3410 WORTH ST, SUITE 235
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City | DALLAS
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State | TX
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Zip | 75246
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Country | US
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Telephone | 469-800-7370
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Fax |
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Provider Business Mailing Address
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Address Line | 3410 WORTH ST STE 235
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City | DALLAS
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State | TX
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Zip | 75246-2071
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Country | US
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Telephone | 469-800-7370
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 51235
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 208G00000X
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Taxonomy Name | Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
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License Number | 51235
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License Number State | MN
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