Provider Demographics
NPI:1407895121
Name:GLYNN, JOHN (DO)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:GLYNN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:680 N LAKE SHORE DR
Mailing Address - Street 2:SUITE 818
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-4546
Mailing Address - Country:US
Mailing Address - Phone:312-926-6146
Mailing Address - Fax:312-926-4398
Practice Address - Street 1:676 N SAINT CLAIR ST
Practice Address - Street 2:SUITE 415
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-2927
Practice Address - Country:US
Practice Address - Phone:312-926-6146
Practice Address - Fax:312-926-4398
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2014-08-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036082875207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF53061Medicare UPIN