Provider Demographics
NPI:1407058233
Name:GLIKIN, SERGEY EFIM (C-SA)
Entity Type:Individual
Prefix:
First Name:SERGEY
Middle Name:EFIM
Last Name:GLIKIN
Suffix:
Gender:M
Credentials:C-SA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 GREENVIEW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60062-6626
Mailing Address - Country:US
Mailing Address - Phone:847-456-3018
Mailing Address - Fax:
Practice Address - Street 1:2025 GREENVIEW RD
Practice Address - Street 2:
Practice Address - City:NORTHBROOK
Practice Address - State:IL
Practice Address - Zip Code:60062
Practice Address - Country:US
Practice Address - Phone:847-456-3018
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical