MEDICARE: STEPHEN GLOUBERMAN 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	174400000X	Specialist	8891	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110639	OTHER	AZ	PIN NUMBER MEDICARE FOR N

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558363747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN GLOUBERMAN MD

Provider Business Mailing Address
First Line	:	3020 E CAMELBACK RD
Second Line	:	SUITE 301
City	:	PHOENIX
State	:	AZ
Zip	:	85016-5095
Country	:	US
Telephone Number	:	602-279-3575
Fax Number	:	602-279-2666

Provider Business Practice Location Address
First Line	:	9250 N 3RD ST STE 2015
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-2404
Country	:	US
Telephone Number	:	602-279-3575
Fax Number	:	602-279-2666

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

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	02/16/2017

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Directions to “ STEPHEN GLOUBERMAN MD” Practice Location

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