Provider Demographics
NPI:1285305144
Name:GLICK MEDICAL GROUP, PLLC
Entity type:Organization
Organization Name:GLICK MEDICAL GROUP, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHANTEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:623-329-5416
Mailing Address - Street 1:7659 E PINNACLE PEAK RD STE 105
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-6298
Mailing Address - Country:US
Mailing Address - Phone:480-222-4600
Mailing Address - Fax:480-222-4619
Practice Address - Street 1:7659 E PINNACLE PEAK RD STE 105
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-6298
Practice Address - Country:US
Practice Address - Phone:480-222-4600
Practice Address - Fax:480-222-4619
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRATIVE HEALTH INSTITUTE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-09-21
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ178737OtherFAMILY PRACTICE