Provider Demographics
NPI:1821230194
Name:SIZEMORE, GLEN WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:WILLIAM
Last Name:SIZEMORE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 PROSPECT AVE
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:IL
Mailing Address - Zip Code:60093-1926
Mailing Address - Country:US
Mailing Address - Phone:847-441-9139
Mailing Address - Fax:
Practice Address - Street 1:807 PROSPECT AVE
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:IL
Practice Address - Zip Code:60093-1926
Practice Address - Country:US
Practice Address - Phone:847-441-9139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-01
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.067583207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism