Provider Demographics
NPI:1215151857
Name:SCOTT D. GLAZER, M.D., S.C.
Entity type:Organization
Organization Name:SCOTT D. GLAZER, M.D., S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:CPC-D
Authorized Official - Phone:847-459-6495
Mailing Address - Street 1:600 W LAKE COOK RD STE 110
Mailing Address - Street 2:
Mailing Address - City:BUFFALO GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60089-2085
Mailing Address - Country:US
Mailing Address - Phone:847-459-6611
Mailing Address - Fax:847-459-7929
Practice Address - Street 1:600 W LAKE COOK RD STE 110
Practice Address - Street 2:
Practice Address - City:BUFFALO GROVE
Practice Address - State:IL
Practice Address - Zip Code:60089-2085
Practice Address - Country:US
Practice Address - Phone:847-459-6611
Practice Address - Fax:847-459-6621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2014-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036059380207N00000X, 207NI0002X, 207NS0135X
IL036073084207N00000X, 207NI0002X, 207NS0135X
IL036102194207N00000X, 207NI0002X, 207NS0135X
IL036111358207N00000X, 207NI0002X, 207NS0135X
IL036062019207NS0135X
IL036062967207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207NI0002XAllopathic & Osteopathic PhysiciansDermatologyClinical & Laboratory Dermatological ImmunologyGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL31601993OtherBCBS GROUP PIN#
IL1114957156OtherDR. BARSKY NPI
IL14D0886350OtherCLIA#
ILD13565OtherARNOLD ROBIN, MD MC UPIN
1770587206OtherGLAZER NPI
1578552246OtherFORRESTAL NPI#
ILC25911Medicare UPIN
ILE18712Medicare UPIN
ILK21894Medicare ID - Type UnspecifiedSDG PROVIDER#
ILK21893Medicare ID - Type UnspecifiedFORRESTAL MEDICARE PIN#
IL31601993OtherBCBS GROUP PIN#
ILB54301Medicare UPIN
ILI43875Medicare UPIN
ILK21895Medicare ID - Type UnspecifiedKMK PROVIDER#
ILK21672Medicare ID - Type UnspecifiedMSR PROVIDER#
IL212426Medicare ID - Type UnspecifiedGROUP MC #
ILK21892Medicare ID - Type UnspecifiedMHF PROVIDER#
ILE18712Medicare ID - Type UnspecifiedFORRESTAL UPIN
ILD13565OtherARNOLD ROBIN, MD MC UPIN
IL14D0886350OtherCLIA#
ILC43141Medicare UPIN
ILH16889Medicare UPIN