Provider Demographics
NPI:1184610263
Name:GLEZER, JEFFREY A (MD)
Entity type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:GLEZER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:1750 E LAKE SHORE DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3803
Mailing Address - Country:US
Mailing Address - Phone:217-428-6300
Mailing Address - Fax:217-233-6068
Practice Address - Street 1:1405 W PARK ST
Practice Address - Street 2:SUITE 301A
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2367
Practice Address - Country:US
Practice Address - Phone:217-531-5466
Practice Address - Fax:217-337-2436
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2007-11-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILG37728Medicare UPIN
ILK46202Medicare PIN