Provider Demographics
NPI:1740238559
Name:GLOWACKI, PAUL V (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:V
Last Name:GLOWACKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:350 WEST 23RD ST.
Mailing Address - Street 2:SUITE G
Mailing Address - City:FREMONT
Mailing Address - State:NE
Mailing Address - Zip Code:68025-2300
Mailing Address - Country:US
Mailing Address - Phone:402-721-5727
Mailing Address - Fax:402-753-6096
Practice Address - Street 1:350 W 23RD ST
Practice Address - Street 2:SUITE G
Practice Address - City:FREMONT
Practice Address - State:NE
Practice Address - Zip Code:68025-2592
Practice Address - Country:US
Practice Address - Phone:402-721-5727
Practice Address - Fax:402-753-6096
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2012-05-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE19985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE269030Medicare ID - Type Unspecified
NEG14617Medicare UPIN