Provider Demographics
NPI:1326085978
Name:GLENWOOD MEDICAL CORP LTD
Entity Type:Organization
Organization Name:GLENWOOD MEDICAL CORP LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PRESIDENT OF CORPORATION
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:B
Authorized Official - Last Name:BRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:708-873-7775
Mailing Address - Street 1:10735 W 159TH STREET
Mailing Address - Street 2:
Mailing Address - City:ORLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60467
Mailing Address - Country:US
Mailing Address - Phone:708-873-7775
Mailing Address - Fax:708-873-0192
Practice Address - Street 1:10735 W 159TH STREET
Practice Address - Street 2:
Practice Address - City:ORLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60467
Practice Address - Country:US
Practice Address - Phone:708-873-7775
Practice Address - Fax:708-873-0192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
C39483Medicare UPIN
IL737820Medicare ID - Type Unspecified