Provider Demographics
NPI:1831152529
Name:GLUCK, JOAN C (MD)
Entity type:Individual
Prefix:DR
First Name:JOAN
Middle Name:C
Last Name:GLUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11880 SW 40TH ST
Mailing Address - Street 2:SUITE 304
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-3584
Mailing Address - Country:US
Mailing Address - Phone:305-223-8808
Mailing Address - Fax:305-223-8974
Practice Address - Street 1:9035 SUNSET DR
Practice Address - Street 2:SUITE 202
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3441
Practice Address - Country:US
Practice Address - Phone:305-279-3366
Practice Address - Fax:305-271-3355
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-11
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0020681174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL045432000Medicaid
FL92540ZMedicare ID - Type Unspecified
FL045432000Medicaid