Provider Demographics
NPI:1720075484
Name:GLAS, RONALD J (MD)
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:J
Last Name:GLAS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1247 RICKERT DR
Mailing Address - Street 2:STE 201
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-1008
Mailing Address - Country:US
Mailing Address - Phone:630-357-7979
Mailing Address - Fax:630-357-1047
Practice Address - Street 1:1247 RICKERT DR
Practice Address - Street 2:STE 201
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-1008
Practice Address - Country:US
Practice Address - Phone:630-357-7979
Practice Address - Fax:630-357-1047
Is Sole Proprietor?:No
Enumeration Date:2005-09-28
Last Update Date:2021-02-23
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Provider Licenses
StateLicense IDTaxonomies
IL036098149207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036098149 1Medicaid
IL2220936OtherBCBS
IL2220936OtherBCBS
IL080147098Medicare PIN
G98186Medicare UPIN