MEDICARE: DR. MARK GLAZER 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
1	207W00000X	Ophthalmology Physician	036-066674	IL

General Provider Information

NPI Number	:	1962680363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK GLAZER M.D.

Provider Business Mailing Address
First Line	:	1110 SHERIDAN RD
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4119
Country	:	US
Telephone Number	:	847-217-8122
Fax Number	:	847-433-6341

Provider Business Practice Location Address
First Line	:	1110 SHERIDAN RD
Second Line	:
City	:	HIGHLAND PARK
State	:	IL
Zip	:	60035-4119
Country	:	US
Telephone Number	:	847-217-8122
Fax Number	:	847-433-6341

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

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	05/09/2008

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