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NPI Code Detail

MEDICARE: DR. JAMES DOUGLAS GLASS M.D.

MEDICARE: DR. JAMES DOUGLAS GLASS 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
1207L00000XAnesthesiology Physician0101058963VA
2207L00000XAnesthesiology PhysicianC54882CA
3207L00000XAnesthesiology Physician036.119299IL
4207L00000XAnesthesiology PhysicianD0067950MD

General Provider Information

NPI Number : 1750380820
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES DOUGLAS GLASS M.D.
Provider Business Mailing Address
First Line : 2950 N SHERIDAN RD APT 1202
Second Line :
City : CHICAGO
State : IL
Zip : 60657-0952
Country : US
Telephone Number : 312-754-8596
Fax Number :
Provider Business Practice Location Address
First Line : 355 RIDGE AVE
Second Line :
City : EVANSTON
State : IL
Zip : 60202-3328
Country : US
Telephone Number : 847-316-4000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/20/2005
Last Update Date : 10/08/2020

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