MEDICARE: DR. GLENN L ZELLMAN MD

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	207NS0135X	Procedural Dermatology Physician	ME0072954	FL

General Provider Information

NPI Number	:	1285611582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GLENN L ZELLMAN MD

Provider Business Mailing Address
First Line	:	2224 W NORTHERN AVE STE D300
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021-5099
Country	:	US
Telephone Number	:	602-277-1449
Fax Number	:	602-277-9984

Provider Business Practice Location Address
First Line	:	2224 W NORTHERN AVE STE D300
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85021
Country	:	US
Telephone Number	:	602-277-1449
Fax Number	:	602-277-9984

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

Provider Enumeration Date	:	12/28/2005
Last Update Date	:	10/24/2018

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