Provider Demographics
NPI:1275572893
Name:GLICK, MICHAEL ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:ALLEN
Last Name:GLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1501 N US HIGHWAY 441
Mailing Address - Street 2:SUITE1102
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8999
Mailing Address - Country:US
Mailing Address - Phone:352-753-5222
Mailing Address - Fax:352-753-6483
Practice Address - Street 1:1501 N US HIGHWAY 441
Practice Address - Street 2:SUITE1102
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8999
Practice Address - Country:US
Practice Address - Phone:352-753-5222
Practice Address - Fax:352-753-6483
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-06
Last Update Date:2016-01-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0051531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD61502Medicare UPIN
FL07372YMedicare PIN