Provider Demographics
NPI:1104863406
Name:GOLBUS, GLENN ALAN (MD)
Entity Type:Individual
Prefix:
First Name:GLENN
Middle Name:ALAN
Last Name:GOLBUS
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 1:1919 S HIGHLAND AVE
Mailing Address - Street 2:SUITE B202 ATTN JAN LEWIS
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-6153
Mailing Address - Country:US
Mailing Address - Phone:630-268-1102
Mailing Address - Fax:630-268-1125
Practice Address - Street 1:1555 BARRINGTON RD
Practice Address - Street 2:BLDG 3 SUITE 3200
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60194-1018
Practice Address - Country:US
Practice Address - Phone:847-882-8448
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILL89705Medicare ID - Type UnspecifiedLOC 16
IL200370Medicare ID - Type UnspecifiedLOC 15
C44202Medicare UPIN
ILL96220Medicare ID - Type UnspecifiedLOC 99