Provider Demographics
NPI:1942329321
Name:GLUCK, IRIS (MD)
Entity Type:Individual
Prefix:DR
First Name:IRIS
Middle Name:
Last Name:GLUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1457 WISTERIA DR
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-4643
Mailing Address - Country:US
Mailing Address - Phone:734-936-8207
Mailing Address - Fax:
Practice Address - Street 1:1500 E MEDICAL CENTER DR
Practice Address - Street 2:UHB2C490
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48109-0999
Practice Address - Country:US
Practice Address - Phone:734-936-8207
Practice Address - Fax:734-763-7370
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010880962085R0001X, 390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Not Answered390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program