Provider Demographics
NPI:1578550273
Name:GLEICHER, HERMAN (MD)
Entity Type:Individual
Prefix:
First Name:HERMAN
Middle Name:
Last Name:GLEICHER
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:PO BOX 495009
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5009
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18316 MURDOCK CIR UNIT 108
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1029
Practice Address - Country:US
Practice Address - Phone:941-629-3502
Practice Address - Fax:941-629-3100
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2019-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 93953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI39568Medicare UPIN
FLU5664UMedicare PIN
FLU5664ZMedicare ID - Type Unspecified