Provider Demographics
NPI:1487792420
Name:ROBERT S GLICK DPM PC
Entity type:Organization
Organization Name:ROBERT S GLICK DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:S
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:312-243-3131
Mailing Address - Street 1:1630 W 18TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60608-2817
Mailing Address - Country:US
Mailing Address - Phone:312-243-3131
Mailing Address - Fax:
Practice Address - Street 1:1630 W 18TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60608-2817
Practice Address - Country:US
Practice Address - Phone:312-243-3131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-02
Last Update Date:2013-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016002695332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
0527240001OtherNATIONAL SUPPLIER ID