Provider Demographics
NPI:1538263884
Name:GLICK, RICHARD STEPHEN (MD)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:STEPHEN
Last Name:GLICK
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 1:6405 NORTH FEDERAL HIGHWAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308
Mailing Address - Country:US
Mailing Address - Phone:954-772-3660
Mailing Address - Fax:954-772-0800
Practice Address - Street 1:6405 NORTH FEDERAL HIGHWAY
Practice Address - Street 2:SUITE 105
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308
Practice Address - Country:US
Practice Address - Phone:954-772-3660
Practice Address - Fax:954-772-0800
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME32732207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL93730OtherBCBS OF FLORIDA
D64611Medicare UPIN
93730Medicare ID - Type Unspecified