Provider Demographics
NPI:1306869599
Name:GLICK, JAMES MICHAEL (MD)
Entity type:Individual
Prefix:MR
First Name:JAMES
Middle Name:MICHAEL
Last Name:GLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2299 POST ST
Mailing Address - Street 2:#107
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3443
Mailing Address - Country:US
Mailing Address - Phone:415-345-9400
Mailing Address - Fax:415-345-8049
Practice Address - Street 1:2299 POST ST
Practice Address - Street 2:#107
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3443
Practice Address - Country:US
Practice Address - Phone:415-345-9400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG026584207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
00C265840Medicare ID - Type Unspecified
A33162Medicare UPIN