Provider Demographics
NPI:1730152141
Name:GLICKMAN, STEVEN H (DPM)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:H
Last Name:GLICKMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4770 ROCHESTER RD
Mailing Address - Street 2:STE 104
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085
Mailing Address - Country:US
Mailing Address - Phone:248-689-5125
Mailing Address - Fax:248-689-5688
Practice Address - Street 1:4770 ROCHESTER RD
Practice Address - Street 2:STE 104
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085
Practice Address - Country:US
Practice Address - Phone:248-689-5125
Practice Address - Fax:248-689-5688
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901000600213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1375192Medicaid
OF37223002Medicare ID - Type Unspecified
MI1375192Medicaid