Provider Demographics
NPI:1023198348
Name:GLUCKIN, JAMES E (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:E
Last Name:GLUCKIN
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 1:2222 W LEXINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-1420
Mailing Address - Country:US
Mailing Address - Phone:574-294-3030
Mailing Address - Fax:574-294-3544
Practice Address - Street 1:2222 W LEXINGTON AVE
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-1420
Practice Address - Country:US
Practice Address - Phone:574-294-3030
Practice Address - Fax:574-294-3544
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN0125765A207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN223580Medicare ID - Type Unspecified
D69489Medicare UPIN