MEDICARE: GLICK MEDICAL GROUP, PLLC

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	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Z178737	OTHER	AZ	FAMILY PRACTICE

General Provider Information

NPI Number	:	1285305144
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLICK MEDICAL GROUP, PLLC

Provider Business Mailing Address
First Line	:	7659 E PINNACLE PEAK RD STE 105
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-6298
Country	:	US
Telephone Number	:	480-222-4600
Fax Number	:	480-222-4619

Provider Business Practice Location Address
First Line	:	7659 E PINNACLE PEAK RD STE 105
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85255-6298
Country	:	US
Telephone Number	:	480-222-4600
Fax Number	:	480-222-4619

Authorized Official
Title or Position	:	OWNER
Name	:	SHANTEL GLICK
Credential	:	PA-C
Telephone Number	:	623-329-5416

Provider Enumeration Date	:	09/21/2021
Last Update Date	:	10/11/2021

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Directions to “GLICK MEDICAL GROUP, PLLC ” Practice Location

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