Provider Demographics
NPI:1316076946
Name:HARRISON, GLENN ALDEN (MD)
Entity type:Individual
Prefix:DR
First Name:GLENN
Middle Name:ALDEN
Last Name:HARRISON
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Gender:M
Credentials:MD
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Mailing Address - Street 1:7301 N LINCOLN AVE
Mailing Address - Street 2:STE 183
Mailing Address - City:LINCOLNWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60712-1736
Mailing Address - Country:US
Mailing Address - Phone:224-766-7669
Mailing Address - Fax:847-674-0892
Practice Address - Street 1:3319 N ELSTON AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-5811
Practice Address - Country:US
Practice Address - Phone:773-751-7200
Practice Address - Fax:773-583-4295
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2017-02-02
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Provider Licenses
StateLicense IDTaxonomies
IL036091413207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG61120Medicare UPIN