Provider Demographics
NPI:1134511025
Name:RICHARD GLICK, M.D.
Entity Type:Organization
Organization Name:RICHARD GLICK, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SALAZAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-530-3499
Mailing Address - Street 1:6405 N FEDERAL HWY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1412
Mailing Address - Country:US
Mailing Address - Phone:910-772-3660
Mailing Address - Fax:954-772-0800
Practice Address - Street 1:6405 N FEDERAL HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1412
Practice Address - Country:US
Practice Address - Phone:910-772-3660
Practice Address - Fax:954-772-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93730OtherMEIDCARE PTAN