MEDICARE: AAP DERMATOLOGY & COSMETIC SURGERY, P.C.

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	207N00000X	Dermatology Physician	2012	AZ

General Provider Information

NPI Number	:	1174730147
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AAP DERMATOLOGY & COSMETIC SURGERY, P.C.

Provider Business Mailing Address
First Line	:	3940 E UNIVERSITY DR
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85205-6945
Country	:	US
Telephone Number	:	480-924-9235
Fax Number	:	480-832-5501

Provider Business Practice Location Address
First Line	:	3940 E UNIVERSITY DR
Second Line	:	SUITE ONE
City	:	MESA
State	:	AZ
Zip	:	85205-6945
Country	:	US
Telephone Number	:	480-924-9235
Fax Number	:	480-832-5501

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RONALD M GLICK
Credential	:	D.O.
Telephone Number	:	480-924-9235

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	02/09/2022

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