Provider Demographics
NPI:1760443261
Name:GLASS, JEFFREY J (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:J
Last Name:GLASS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1770 1ST ST
Mailing Address - Street 2:SUITE 300
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-3200
Mailing Address - Country:US
Mailing Address - Phone:847-433-6990
Mailing Address - Fax:847-433-8738
Practice Address - Street 1:1770 1ST ST
Practice Address - Street 2:SUITE 300
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-3200
Practice Address - Country:US
Practice Address - Phone:847-433-6990
Practice Address - Fax:847-433-8738
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-01
Last Update Date:2024-03-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-045836207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL14D0412756OtherCLIA
IL14D0412756OtherCLIA
IL362853873OtherITIN
IL245150Medicare ID - Type Unspecified