Provider Demographics
NPI:1629259809
Name:WINTER, GLENN M (MD)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:M
Last Name:WINTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1229 N NORTH BRANCH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60622-2473
Mailing Address - Country:US
Mailing Address - Phone:312-939-5090
Mailing Address - Fax:
Practice Address - Street 1:1229 N NORTH BRANCH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60622-2473
Practice Address - Country:US
Practice Address - Phone:312-939-5090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-16
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036051330207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine