Provider Demographics
NPI:1528268430
Name:HERMAN GLEICHER MD PA
Entity type:Organization
Organization Name:HERMAN GLEICHER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HERMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEICHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-889-7440
Mailing Address - Street 1:PO BOX 495009
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33949-5009
Mailing Address - Country:US
Mailing Address - Phone:941-889-7440
Mailing Address - Fax:941-391-6089
Practice Address - Street 1:21202 OLEAN BLVD
Practice Address - Street 2:UNIT C-1
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-6751
Practice Address - Country:US
Practice Address - Phone:941-889-7440
Practice Address - Fax:941-391-6089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-19
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME93953207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277499200Medicaid
U5664Medicare PIN
FLAF723AMedicare PIN
I39568Medicare UPIN