Provider Demographics
NPI:1013903509
Name:GLICK, BARRY (DO)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:
Last Name:GLICK
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:810 BIESTERFIELD RD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-7312
Mailing Address - Country:US
Mailing Address - Phone:847-981-6061
Mailing Address - Fax:847-981-6062
Practice Address - Street 1:810 BIESTERFIELD RD
Practice Address - Street 2:SUITE 306
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-7312
Practice Address - Country:US
Practice Address - Phone:847-981-6061
Practice Address - Fax:847-981-6062
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-091531207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG15691Medicare UPIN