Provider Demographics
NPI:1982709168
Name:GLICK, ROBERTA PEARL (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:PEARL
Last Name:GLICK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1522 DAVIS ST
Mailing Address - Street 2:
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4010
Mailing Address - Country:US
Mailing Address - Phone:312-864-5120
Mailing Address - Fax:312-864-9606
Practice Address - Street 1:1901 W HARRISON ST DEPT NEUROSURGE
Practice Address - Street 2:JOHN H STROGERER HOSPITAL - SUITE 643
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60612-3714
Practice Address - Country:US
Practice Address - Phone:312-864-5120
Practice Address - Fax:312-864-9606
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery