MEDICARE: GLENDALE MEDICAL CLINIC LLC

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1952887655
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GLENDALE MEDICAL CLINIC LLC

Provider Business Mailing Address
First Line	:	7800 N 55TH AVE STE 106
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-1322
Country	:	US
Telephone Number	:	905-405-8452
Fax Number	:

Provider Business Practice Location Address
First Line	:	7800 N 55TH AVE STE 106
Second Line	:
City	:	GLENDALE
State	:	AZ
Zip	:	85301-1322
Country	:	US
Telephone Number	:	905-405-8452
Fax Number	:

Authorized Official
Title or Position	:	MEMBER/MANAGING EMPLOYEE
Name	:	DR. BIKRAMJIT NANAR
Credential	:	MD
Telephone Number	:	905-405-8452

Provider Enumeration Date	:	07/16/2018
Last Update Date	:	07/16/2018

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