Provider Demographics
NPI:1588601611
Name:GLUCK, PAUL ALVIN (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:ALVIN
Last Name:GLUCK
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 1:8950 N KENDALL DRIVE
Mailing Address - Street 2:#507
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33176
Mailing Address - Country:US
Mailing Address - Phone:305-279-3773
Mailing Address - Fax:305-271-9862
Practice Address - Street 1:8950 N KENDALL DRIVE
Practice Address - Street 2:#507
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176
Practice Address - Country:US
Practice Address - Phone:305-279-3773
Practice Address - Fax:305-271-9862
Is Sole Proprietor?:No
Enumeration Date:2006-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20682207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
D60086Medicare UPIN
92507Medicare ID - Type Unspecified