Provider Demographics
NPI:1619304342
Name:GLUECK MD, LLC
Entity Type:Organization
Organization Name:GLUECK MD, LLC
Other - Org Name:REPRODUCTIVE AND ENDOCRINE HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:SHANA
Authorized Official - Last Name:GLUECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:917-903-7047
Mailing Address - Street 1:600 CENTRAL AVE
Mailing Address - Street 2:SUITE 315
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3211
Mailing Address - Country:US
Mailing Address - Phone:847-786-0048
Mailing Address - Fax:
Practice Address - Street 1:600 CENTRAL AVE
Practice Address - Street 2:SUITE 315
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3211
Practice Address - Country:US
Practice Address - Phone:847-786-0048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-26
Last Update Date:2014-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036133880261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001060800Medicaid