Provider Demographics
NPI:1790102002
Name:GLOTFELTY, LILA G (MD)
Entity type:Individual
Prefix:
First Name:LILA
Middle Name:G
Last Name:GLOTFELTY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LILA
Other - Middle Name:GOLLOGLY
Other - Last Name:GLOTFELTY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:360E RANDOLPH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60601-5069
Mailing Address - Country:US
Mailing Address - Phone:312-607-8004
Mailing Address - Fax:
Practice Address - Street 1:1740 W TAYLOR ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-7232
Practice Address - Country:US
Practice Address - Phone:866-600-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-25
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125065048207R00000X
CODR.0067827207R00000X
VA0101276207207RG0100X
390200000X
IL036143216207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program