MEDICARE: DR. GLEN MICHAEL WOOL 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	207R00000X	Internal Medicine Physician	G50570	CA

General Provider Information

NPI Number	:	1265598593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLEN MICHAEL WOOL M.D.

Provider Business Mailing Address
First Line	:	300 S BEVERLY DR
Second Line	:	SUITE #108
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-4808
Country	:	US
Telephone Number	:	310-556-7991
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S BEVERLY DR
Second Line	:	SUITE #108
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-4808
Country	:	US
Telephone Number	:	310-556-7991
Fax Number	:

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

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	05/13/2024

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