Provider Demographics
NPI:1770757304
Name:ELK GROVE MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:ELK GROVE MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:GLICK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:312-505-1845
Mailing Address - Street 1:800 BIESTERFIELD RD STE 625
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60007-3362
Mailing Address - Country:US
Mailing Address - Phone:847-981-6061
Mailing Address - Fax:872-241-0118
Practice Address - Street 1:800 BIESTERFIELD RD STE 625
Practice Address - Street 2:
Practice Address - City:ELK GROVE VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60007-3362
Practice Address - Country:US
Practice Address - Phone:847-981-6061
Practice Address - Fax:872-241-0118
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty