Provider Demographics
NPI:1962680363
Name:GLAZER, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:GLAZER
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1110 SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4119
Mailing Address - Country:US
Mailing Address - Phone:847-217-8122
Mailing Address - Fax:847-433-6341
Practice Address - Street 1:1110 SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4119
Practice Address - Country:US
Practice Address - Phone:847-217-8122
Practice Address - Fax:847-433-6341
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2008-05-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036-066674207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
0839990001Medicare NSC