Provider Demographics
NPI:1891911756
Name:BORIS GLINER MD
Entity Type:Organization
Organization Name:BORIS GLINER MD
Other - Org Name:INTERNAL MEDICINE GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BORIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GLINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-661-1123
Mailing Address - Street 1:1440 ROCKSIDE RD
Mailing Address - Street 2:
Mailing Address - City:PARMA
Mailing Address - State:OH
Mailing Address - Zip Code:44134-2774
Mailing Address - Country:US
Mailing Address - Phone:216-661-1123
Mailing Address - Fax:216-661-4445
Practice Address - Street 1:1440 ROCKSIDE ROAD #215 ROCKSIDE PLAZA
Practice Address - Street 2:
Practice Address - City:PARMA
Practice Address - State:OH
Practice Address - Zip Code:44134
Practice Address - Country:US
Practice Address - Phone:216-661-1123
Practice Address - Fax:216-661-4445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-18
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0002XAllopathic & Osteopathic PhysiciansInternal MedicineHospice and Palliative MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9933022Medicare ID - Type UnspecifiedMEDICARE