Provider Demographics
NPI:1003925173
Name:GLANZ, STEVEN M
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:M
Last Name:GLANZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 SW 18TH ST
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-6762
Mailing Address - Country:US
Mailing Address - Phone:561-322-8545
Mailing Address - Fax:
Practice Address - Street 1:7112 BERACASA WAY
Practice Address - Street 2:SUITE 125
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433
Practice Address - Country:US
Practice Address - Phone:561-322-8545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58607207ND0900X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2529142Medicaid
FL370769501Medicaid
FL14634ZMedicare Oscar/Certification
FL14634ZMedicare UPIN
FL14634TMedicare PIN