Provider Demographics
NPI:1639188329
Name:MICHAEL GLICK, M.D. P.A.
Entity Type:Organization
Organization Name:MICHAEL GLICK, M.D. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-753-5222
Mailing Address - Street 1:1501 N US HIGHWAY 441
Mailing Address - Street 2:SUITE 1102
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32159-8999
Mailing Address - Country:US
Mailing Address - Phone:352-753-5222
Mailing Address - Fax:352-753-6483
Practice Address - Street 1:1501 N US HIGHWAY 441
Practice Address - Street 2:SUITE 1102
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32159-8999
Practice Address - Country:US
Practice Address - Phone:352-753-5222
Practice Address - Fax:352-753-6483
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21793OtherBCBS FLORIDA PROVIDER ID
FL=========OtherTAX ID
FL=========OtherTAX ID