Provider Demographics
NPI:1750347803
Name:GLANTSMAN, BELA (MD)
Entity type:Individual
Prefix:
First Name:BELA
Middle Name:
Last Name:GLANTSMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:333 E IL ROUTE 83 STE 105
Mailing Address - Street 2:
Mailing Address - City:MUNDELEIN
Mailing Address - State:IL
Mailing Address - Zip Code:60060-4278
Mailing Address - Country:US
Mailing Address - Phone:847-970-9922
Mailing Address - Fax:847-970-9955
Practice Address - Street 1:333 E IL ROUTE 83 STE 105
Practice Address - Street 2:
Practice Address - City:MUNDELEIN
Practice Address - State:IL
Practice Address - Zip Code:60060-4278
Practice Address - Country:US
Practice Address - Phone:847-970-9922
Practice Address - Fax:847-970-9955
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2020-03-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036-111232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036-111232OtherLICENSE NO.