Provider Demographics
NPI:1689601874
Name:GLICK, SETH H (MD)
Entity Type:Individual
Prefix:DR
First Name:SETH
Middle Name:H
Last Name:GLICK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3300 S FISKE BLVD
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32955-4306
Mailing Address - Country:US
Mailing Address - Phone:321-631-2070
Mailing Address - Fax:321-951-7408
Practice Address - Street 1:699 W COCOA BEACH CSWY STE 506
Practice Address - Street 2:
Practice Address - City:COCOA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32931-3562
Practice Address - Country:US
Practice Address - Phone:321-630-2070
Practice Address - Fax:321-631-6489
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME99573208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001359800Medicaid
FL001359800Medicaid