Provider Demographics
NPI:1568424836
Name:GLICKSMAN, HOWARD M (MD)
Entity Type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:M
Last Name:GLICKSMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17757 US HWY 19 NORTH
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6560
Mailing Address - Country:US
Mailing Address - Phone:727-450-2210
Mailing Address - Fax:727-450-2235
Practice Address - Street 1:7154 MEDICAL CENTER DRIVE
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34608-1329
Practice Address - Country:US
Practice Address - Phone:352-596-1926
Practice Address - Fax:352-597-2154
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2008-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL041596208D00000X
FLME41596207RH0002X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00468392OtherRAILROAD MEDICARE
FL068222500Medicaid
FL26062AMedicare ID - Type Unspecified
26062Medicare PIN
FL068222500Medicaid
FL26062XMedicare PIN
FL26062Medicare PIN