Provider Demographics
NPI:1912101254
Name:GLEIXNER, PAUL HENRY (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:HENRY
Last Name:GLEIXNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 REMINGTON BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:BOLINGBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60440-4707
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:630-914-2469
Practice Address - Street 1:7447 W TALCOTT AVE
Practice Address - Street 2:SUITE 418
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60631
Practice Address - Country:US
Practice Address - Phone:773-775-2180
Practice Address - Fax:773-775-8996
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-116579207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1621149OtherBLUE SHIELD PROVIDER ID
IL282810Medicare ID - Type UnspecifiedGROUP MEDICARE ID #