MEDICARE: DR. GEORGE MICHAEL GLANTZ M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	11150	FL

General Provider Information

NPI Number	:	1154641611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE MICHAEL GLANTZ M.D.

Provider Business Mailing Address
First Line	:	3630 N 52 AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2248
Country	:	US
Telephone Number	:	954-963-3645
Fax Number	:	954-963-4436

Provider Business Practice Location Address
First Line	:	3630 N 52 AVE
Second Line	:
City	:	HOLLYWOOD
State	:	FL
Zip	:	33021-2248
Country	:	US
Telephone Number	:	954-963-3645
Fax Number	:	954-963-4436

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/08/2010
Last Update Date	:	06/08/2010

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